Provider Demographics
NPI:1447310370
Name:LOPEZ, CELINA ALEXIS (LPC)
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:ALEXIS
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:LEAKEY
Mailing Address - State:TX
Mailing Address - Zip Code:78873-0689
Mailing Address - Country:US
Mailing Address - Phone:830-232-6590
Mailing Address - Fax:830-232-6522
Practice Address - Street 1:4243 E PIEDRAS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1421
Practice Address - Country:US
Practice Address - Phone:210-733-7117
Practice Address - Fax:210-733-7118
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1791956-01Medicaid