Provider Demographics
NPI:1063981025
Name:LOPEZ, JUCHIA CRYSTAL (LPCC)
Entity type:Individual
Prefix:MS
First Name:JUCHIA
Middle Name:CRYSTAL
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 E CARAMILLO ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2857
Mailing Address - Country:US
Mailing Address - Phone:254-371-1622
Mailing Address - Fax:
Practice Address - Street 1:1401 POTTER DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3558
Practice Address - Country:US
Practice Address - Phone:254-371-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0016427103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling