Provider Demographics
NPI:1174775787
Name:HURTADO-LOPEZ, CARLOS ADIAX
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ADIAX
Last Name:HURTADO-LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:ADIAX
Other - Last Name:HURTADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1901 CENTRAL DR STE 160
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5823
Mailing Address - Country:US
Mailing Address - Phone:682-289-0546
Mailing Address - Fax:
Practice Address - Street 1:1901 CENTRAL DR STE 160
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5823
Practice Address - Country:US
Practice Address - Phone:682-289-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)