Doctor Name: | MRS. LISA TATUM LOPEZ |
NPI Number: | 1205021896 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LMHC, CMHS |
License Number: | LH60237309 |
Business Practice Address: | 15408 Main St Unit 107 Mill Creek, WA - 980129025 |
Business Phone Number: | 4257727234 |
Business Fax Number: | 4253770785 |
Mailing Address: | 15408 Main St Unit 107, MILL CREEK |
State: | WA |
Postal Code: | 980129025 |
Phone Number: | 4257727234 |
Fax Number: | 4253770785 |
NPI Enumeration Date: | 09/07/2007 |
NPI Last Update Date: | 09/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LH60237309 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |