Provider Demographics
NPI:1154802882
Name:LOPEZ, JUDITH A (CAC III)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31714
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80041-0714
Mailing Address - Country:US
Mailing Address - Phone:303-341-9160
Mailing Address - Fax:303-343-3907
Practice Address - Street 1:2178 VICTOR ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7440
Practice Address - Country:US
Practice Address - Phone:303-341-9160
Practice Address - Fax:303-343-3907
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7206101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)