Provider Demographics
NPI:1528267119
Name:LOPES, SEBASTIAO IVAN (MS, LPC, LADC)
Entity type:Individual
Prefix:MR
First Name:SEBASTIAO
Middle Name:IVAN
Last Name:LOPES
Suffix:
Gender:M
Credentials:MS, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3301
Mailing Address - Country:US
Mailing Address - Phone:918-293-2140
Mailing Address - Fax:918-712-7164
Practice Address - Street 1:2323 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3301
Practice Address - Country:US
Practice Address - Phone:918-293-2140
Practice Address - Fax:918-712-7164
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3256101YA0400X, 101Y00000X
OK522101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200365530AMedicaid