Individual
MRS. TABITHA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
2145 NICE AVE, MENTONE, CA 92359-9643
(951) 409-6674
Mailing address
42061 FERGUSON DR, HEMET, CA 92544-6474
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
16661
CA
Other
Enumeration date
10/23/2018
Last updated
12/04/2024
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