Doctor Name: | KEITH ALBERT LOPEZ |
NPI Number: | 1457610214 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LAC |
License Number: | 14111 |
Business Practice Address: | 307 E Park Ave Suite 207b Anaconda, MT - 597112320 |
Business Phone Number: | 4065637197 |
Business Fax Number: | 4065637685 |
Mailing Address: | T9 Fort Missoula, MISSOULA |
State: | MT |
Postal Code: | 598047298 |
Phone Number: | 4065328400 |
Fax Number: | 4065439316 |
NPI Enumeration Date: | 05/14/2012 |
NPI Last Update Date: | 05/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 14111 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |