Provider Demographics
NPI:1861067233
Name:LOPEZ, CHANEL SHANNI (MA, LPCC)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:SHANNI
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:CHANEL
Other - Middle Name:SHANNI
Other - Last Name:PURCELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1772 STIEGER LAKE LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-7723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1772 STIEGER LAKE LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-7723
Practice Address - Country:US
Practice Address - Phone:952-443-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN4430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program