Individual
JACEY LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1614 E MAIN ST STE C, NEW IBERIA, LA 70560-4056
(337) 369-6600
(337) 369-1140
Mailing address
2525 YOUREE DR STE 110, SHREVEPORT, LA 71104-3600
(318) 742-3408
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/14/2017
Last updated
08/24/2017
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