Provider Demographics
NPI:1306132980
Name:LOPEZ, DANIEL RAY (COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RAY
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:RAY
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:83844 HOPI AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-2638
Mailing Address - Country:US
Mailing Address - Phone:760-347-9442
Mailing Address - Fax:760-342-8022
Practice Address - Street 1:1612 1ST ST
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1407
Practice Address - Country:US
Practice Address - Phone:760-398-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11180324500000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility