Individual provider Active NPI

Ismary Lopez

  • Mental Health Counselor
  • Lehigh Acres, FL
National Provider Identifier
1306364286
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH19483 Issued in FL
Practice address
222 Lake Dr
Lehigh Acres, FL 33936-7020
Phone
(561) 309-7344
NPI assigned
Aug 31, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH19483 FL Primary

Addresses

Primary practice location

222 Lake Dr
Lehigh Acres, FL 33936-7020

Mailing address

222 Lake Dr
Lehigh Acres, FL 33936-7020
Phone (561) 309-7344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231229001542 FL Practitioner - Mental Health Counselor 3375993520 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Synchronized Counseling Group Mental Health CurrentSince Dec 20, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1306364286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 LAKE DR",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339367020",
            "telephone_number": "561-309-7344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 LAKE DR",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339367020",
            "telephone_number": "561-309-7344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "ISMARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-31",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH19483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehigh Acres, FL

Sources for this page

Verify at the official NPI Registry.