Provider Demographics
NPI:1881485357
Name:LOPEZ, LORENA
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5869
Mailing Address - Country:US
Mailing Address - Phone:530-867-4511
Mailing Address - Fax:
Practice Address - Street 1:26675 PLAINFIELD ST
Practice Address - Street 2:
Practice Address - City:ESPARTO
Practice Address - State:CA
Practice Address - Zip Code:95627-2192
Practice Address - Country:US
Practice Address - Phone:530-787-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240172148101YS0200X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool