Provider Demographics
NPI:1417252214
Name:LOPEZ, SHARON MAE (LSAC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MAE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:UT
Mailing Address - Zip Code:84620-0119
Mailing Address - Country:US
Mailing Address - Phone:435-896-8236
Mailing Address - Fax:
Practice Address - Street 1:152 NORTH 400 WEST
Practice Address - Street 2:
Practice Address - City:EPHRIAM
Practice Address - State:UT
Practice Address - Zip Code:84627-2131
Practice Address - Country:US
Practice Address - Phone:435-283-8400
Practice Address - Fax:435-283-8401
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT124038-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT124038-6006OtherUTAH STATE LICENSE