Provider Demographics
NPI:1114356425
Name:LOPEZ-LONGORIA, LIZET
Entity type:Individual
Prefix:
First Name:LIZET
Middle Name:
Last Name:LOPEZ-LONGORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N LEE TREVINO DR STE C3
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5164
Mailing Address - Country:US
Mailing Address - Phone:915-319-4803
Mailing Address - Fax:
Practice Address - Street 1:1600 N LEE TREVINO DR STE C3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5164
Practice Address - Country:US
Practice Address - Phone:915-319-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64153274Medicaid