Active NPI
Irene Bautista Lopez, MS, LPC, NCC, RPT
- Mental Health Counselor
- Lawrenceville, GA
National Provider Identifier
1164021135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC013408
- Practice address
- 175 Gwinnett Dr
Lawrenceville, GA 30046-8444 - Phone
- (678) 209-2394
- NPI assigned
- Oct 21, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC013408 | GA | Primary |
Addresses
Primary practice location
175 Gwinnett Dr
Lawrenceville, GA 30046-8444
Mailing address
3025-B Bethany Church Rd.
Suite 1300
Norcross, GA 30039
Phone (803) 944-1359
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC013408 | GA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759795200000",
"number": "1164021135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3025-B BETHANY CHURCH RD.",
"address_2": "SUITE 1300",
"city": "NORCROSS",
"state": "GA",
"postal_code": "30039",
"telephone_number": "803-944-1359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 GWINNETT DR",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300468444",
"telephone_number": "678-209-2394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUTISTA LOPEZ",
"first_name": "IRENE",
"credential": "MS, LPC, NCC, RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-21",
"last_updated": "2025-10-07",
"certification_date": "2025-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "LPC013408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.