Individual provider Active NPI

Nicolle Stephany Lopez, AMFT

  • Mental Health Counselor
  • San Diego, CA
National Provider Identifier
1952057648
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
1465 30TH St Ste K
San Diego, CA 92154-3497
Phone
(619) 428-1000
NPI assigned
Feb 22, 2022
Last updated
Dec 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Other Technician 247200000X NU
Mental Health Counselor 101YM0800X NU Primary
Marriage & Family Therapist 106H00000X NU
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

1465 30TH St Ste K
San Diego, CA 92154-3497

Mailing address

272 Church Ave Ste 3
Chula Vista, CA 91910-2718
Phone (619) 737-2989

Other practice location 1

180 E Main St Ste 203
Tustin, CA 92780-4414
Phone (877) 421-1711

Other practice location 2

5000 Birch St Ste 3000
Newport Beach, CA 92660-2140
Phone (877) 421-1711

Other practice location 3

30211 Avenida De Las Bandera # 2000
Rancho Santa Margarita, CA 92688-2147
Phone (877) 421-1711

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

Practice roles

OrganizationSpecialtyStatusNew patients
La Verdad Family Therapy Professional Corporation Marriage & Family Therapist CurrentSince Jan 26, 2025 Accepting new patients
Community Research Foundation PastSince Aug 1, 2023 Accepting new patients

Locations

272 Church Ave
Ste 3
Chula Vista, CA 91910
Phone (619) 737-2989

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1645488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1952057648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 CHURCH AVE STE 3",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102718",
            "telephone_number": "619-737-2989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 30TH ST STE K",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921543497",
            "telephone_number": "619-428-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "180 E Main St Ste 203",
            "address_purpose": "LOCATION",
            "city": "Tustin",
            "state": "CA",
            "postal_code": "927804414",
            "country_code": "US",
            "telephone_number": "877-421-1711",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5000 Birch St Ste 3000",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926602140",
            "country_code": "US",
            "telephone_number": "877-421-1711",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30211 Avenida De Las Bandera # 2000",
            "address_purpose": "LOCATION",
            "city": "Rancho Santa Margarita",
            "state": "CA",
            "postal_code": "926882147",
            "country_code": "US",
            "telephone_number": "877-421-1711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "NICOLLE",
        "middle_name": "STEPHANY",
        "credential": "AMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-22",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.