Provider Demographics
NPI:1649855495
Name:LOPEZ, NANCY LEE (MS, MA, LMFT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, MA, LMFT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:644 E THOMPSON BLVD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2829
Mailing Address - Country:US
Mailing Address - Phone:805-648-2548
Mailing Address - Fax:
Practice Address - Street 1:644 E THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2829
Practice Address - Country:US
Practice Address - Phone:805-648-2548
Practice Address - Fax:805-652-0745
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMH21622106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01OtherINSURANCE COMPANIES