Provider Demographics
NPI:1053112979
Name:BRAVO LOPEZ, LIZARELI (LPC)
Entity type:Individual
Prefix:
First Name:LIZARELI
Middle Name:
Last Name:BRAVO LOPEZ
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 MOULTRIE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7153
Mailing Address - Country:US
Mailing Address - Phone:832-866-8331
Mailing Address - Fax:
Practice Address - Street 1:800 BONAVENTURE WAY STE 156
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8007
Practice Address - Country:US
Practice Address - Phone:346-440-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health