Doctor Name: | LIZET LOPEZ-LONGORIA |
NPI Number: | 1114356425 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | T-0162011 |
Business Practice Address: | 5305 Mcnutt Rd Santa Teresa, NM - 880089685 |
Business Phone Number: | 5758825100 |
Business Fax Number: | 5758821151 |
Mailing Address: | 5305 Mcnutt Rd, SANTA TERESA |
State: | NM |
Postal Code: | 880089685 |
Phone Number: | 5758825100 |
Fax Number: | 5758821151 |
NPI Enumeration Date: | 11/06/2013 |
NPI Last Update Date: | 11/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | T-0162011 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |