Basic Information
| Provider Information | |||||||||
| NPI: | 1316272735 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNETT-LOPEZ | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MPA-LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9459 VALLEY DL | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782503901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104643767 | ||||||||
| FaxNumber: | 2102719414 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 FREDERICKSBURG RD | ||||||||
| Address2: | SUITE 137 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782013269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102651133 | ||||||||
| FaxNumber: | 2102598528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2009 | ||||||||
| LastUpdateDate: | 08/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 8378 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 8378 | 01 | TX | DSHS | OTHER |