Provider Demographics
NPI:1992161756
Name:LOPEZ, EDWARD CHRISTIAN
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:CHRISTIAN
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 E 400 S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2838
Mailing Address - Country:US
Mailing Address - Phone:801-674-5352
Mailing Address - Fax:801-931-2607
Practice Address - Street 1:243 E 400 S
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2838
Practice Address - Country:US
Practice Address - Phone:801-674-5352
Practice Address - Fax:801-931-2607
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-10
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst