Provider Demographics
NPI:1164825824
Name:LOPEZ, DAVID ERIC (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ERIC
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 HUNTINGTON BLVD APT 119
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2310
Mailing Address - Country:US
Mailing Address - Phone:559-630-1265
Mailing Address - Fax:
Practice Address - Street 1:4910 E ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3020
Practice Address - Country:US
Practice Address - Phone:559-630-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health