Individual
DR. JESSIE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
310 E OAK ST, KINGMAN, AZ 86401-5840
(928) 377-1963
Mailing address
2020 JOHN WAYNE DR, KINGMAN, AZ 86409-3189
(928) 377-1963
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301013521
MI
Other
Enumeration date
03/06/2009
Last updated
03/06/2009
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