Provider Demographics
NPI:1154814192
Name:LOPEZ, COURTNEY RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RAE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:RAE
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:8622 MASSEY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7120
Mailing Address - Country:US
Mailing Address - Phone:719-371-2212
Mailing Address - Fax:
Practice Address - Street 1:731 N WEBER ST STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1019
Practice Address - Country:US
Practice Address - Phone:719-371-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099244821041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical