Individual
LAURIE LA VERNE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
829 CHIEF EDDIE HOFFMAN HWY, BETHEL, AK 99559
(907) 543-6107
(907) 543-6008
Mailing address
PO BOX 528, BETHEL, AK 99559
(907) 543-6101
(907) 543-6008
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMG528
—
AK
05
—
MH0150
—
AK
Enumeration date
08/22/2011
Last updated
08/22/2011
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