Provider Demographics
NPI:1467818906
Name:GOMEZ LOPEZ, AYLEEN (MA, LPC, LMHC)
Entity type:Individual
Prefix:
First Name:AYLEEN
Middle Name:
Last Name:GOMEZ LOPEZ
Suffix:
Gender:F
Credentials:MA, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411303
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-1303
Mailing Address - Country:US
Mailing Address - Phone:314-668-2623
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 411303
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32941-1303
Practice Address - Country:US
Practice Address - Phone:314-668-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011039348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional