Individual
SHANE KEITH LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
115 KEATING DR, BELLE CHASSE, LA 70037
(504) 393-5750
Mailing address
115 KEATING DR, BELLE CHASSE, LA 70037-1629
(504) 393-5750
(318) 251-4659
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6551
LA
Other
Enumeration date
02/06/2018
Last updated
03/11/2019
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