Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3-1752 | TX |
Y | 103T00000X | Psychologist | 3-1752 | TX |
N | 103TC1900X | Counseling Psychologist | 31752 | TX |
NPI | 1093826927 |
---|---|
Provider Name | Norma Lopez |
First Address | Austin, TX 78709-1223 |
Second Address | Austin, TX 78748-5714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 17/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0030PB | BCBS (01) | TX |
108173905 | (05) | TX |