Individual
GLORIA BAUTISTA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC,LCDC
Contact information
Practice address
9501 N FM 620 RD APT 4502, AUSTIN, TX 78726-2906
(512) 944-7630
Mailing address
9501 N FM 620 RD APT 4502, AUSTIN, TX 78726-2906
(512) 944-7630
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15714
TX
101YM0800X
Mental Health Counselor
Primary
83770
TX
Other
Enumeration date
05/20/2022
Last updated
07/24/2024
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