Provider Demographics
NPI:1679690713
Name:LOPEZ-FREEMAN, NOEL JUDITH AGOSTON (MA)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:JUDITH AGOSTON
Last Name:LOPEZ-FREEMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270055
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-0055
Mailing Address - Country:US
Mailing Address - Phone:213-999-3456
Mailing Address - Fax:
Practice Address - Street 1:216 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-6914
Practice Address - Country:US
Practice Address - Phone:213-999-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204945106H00000X
CA43215106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist