Provider Demographics
NPI:1346129129
Name:LOPEZ, ALYSHA KRISTINE (AS)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:KRISTINE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:ALYSHA
Other - Middle Name:KRISTINE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AS
Mailing Address - Street 1:6914 BRISBANE CT STE 200
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1922 DRY CREEK WAY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-1840
Practice Address - Country:US
Practice Address - Phone:910-916-4874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB1219307106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician