Individual
JACK LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADCII
Contact information
Practice address
155 NE REVERE AVE STE 150, BEND, OR 97701-4147
(541) 617-4544
(541) 749-2126
Mailing address
155 NE REVERE AVE STE 150, BEND, OR 97701-4147
(541) 617-4544
(541) 749-2126
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16-10-11
OR
Other
Enumeration date
10/26/2018
Last updated
10/26/2018
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