Provider Demographics
NPI:1649855743
Name:LOPEZ, JENNIFER M (LMFT, APCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3974 SORRENTO VALLEY BLVD # 910281
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1410
Mailing Address - Country:US
Mailing Address - Phone:760-840-9800
Mailing Address - Fax:
Practice Address - Street 1:3974 SORRENTO VALLEY BLVD # 910281
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1410
Practice Address - Country:US
Practice Address - Phone:760-840-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT123340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist