Individual ProviderAngel LopezCounselorBehavioral Health & Social Service ProvidersPractice Address339 E Robertson St, Brandon, FL 33511-5253(813) 662-4214(813) 957-6111PECOS EnrollmentBased on the most recent information from CMS, provider Angel Lopez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:06 AM.Profile DetailsProvider ID1891174413Provider TypeIndividualFull NameLopez, AngelTitleMr.CredentialLMHCGenderMaleSole ProprietorYesEnumeration Date5/28/2015Last Updated8/25/2015Contact InformationPractice LocationPractice Address339 E Robertson St, Brandon, FL 33511-5253Phone(813) 662-4214FaxUnlisted FaxMailing LocationMailing Address2008 Redbridge Dr, Brandon, FL 33511-8392Phone(813) 957-6111FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseMH11842Florida