Provider Demographics
NPI:1053860916
Name:LOPEZ, RUEBEN (LLPC)
Entity Type:Individual
Prefix:MR
First Name:RUEBEN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4867 E BELTLINE AVE NE STE 4
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9787
Mailing Address - Country:US
Mailing Address - Phone:616-292-4594
Mailing Address - Fax:
Practice Address - Street 1:4867 E BELTLINE AVE NE STE 4
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9787
Practice Address - Country:US
Practice Address - Phone:616-292-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional