Individual
KEITH ALBERT LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
307 E PARK AVE, SUITE 207B, ANACONDA, MT 59711-2320
(406) 563-7197
(406) 563-7685
Mailing address
T9 FORT MISSOULA, MISSOULA, MT 59804-7298
(406) 532-8400
(406) 543-9316
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14111
MT
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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