Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003132895 |
---|---|
Provider Name | Elise Ana Lopez |
First Address | Fullerton, CA 92831-3847 |
Second Address | Fullerton, CA 92831-3847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2010 |
Last Update Date | 19/04/2010 |