Provider Demographics
NPI:1336385830
Name:LOPEZ, AMPARO (LCPC)
Entity Type:Individual
Prefix:MS
First Name:AMPARO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1306
Mailing Address - Country:US
Mailing Address - Phone:312-545-1563
Mailing Address - Fax:
Practice Address - Street 1:700 N GREEN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5996
Practice Address - Country:US
Practice Address - Phone:312-545-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional