Provider Demographics
NPI:1972274900
Name:LOPEZ, HANNAH (LMSW)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1221 MABLE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-7701
Mailing Address - Country:US
Mailing Address - Phone:479-461-0746
Mailing Address - Fax:
Practice Address - Street 1:104 LOCK AND DAM RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-9725
Practice Address - Country:US
Practice Address - Phone:479-222-0268
Practice Address - Fax:636-324-8551
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR106S00000X
AR13006-M101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR207872706Medicaid