Provider Demographics
NPI:1962876599
Name:LOPEZ, BRITTANY QUINN (BA, QMHA,)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:QUINN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BA, QMHA,
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:QUINN
Other - Last Name:HEALY-TUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:10 SHELTON MCMURPHEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4928
Mailing Address - Country:US
Mailing Address - Phone:541-485-2711
Mailing Address - Fax:888-975-0250
Practice Address - Street 1:10 SHELTON MCMURPHEY BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4928
Practice Address - Country:US
Practice Address - Phone:541-485-2711
Practice Address - Fax:888-975-0250
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORT-16-437101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500696011Medicaid
OR500720429Medicaid