Provider Demographics
NPI:1962464305
Name:LOPEZ, LETICIA G (LPC)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:G
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:LOPEZ-FRANCIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:915 MAZATLAN ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7841
Mailing Address - Country:US
Mailing Address - Phone:956-638-0026
Mailing Address - Fax:
Practice Address - Street 1:915 MAZATLAN ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7841
Practice Address - Country:US
Practice Address - Phone:956-638-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1803280-01Medicaid