Provider Demographics
NPI:1548780216
Name:LOPEZ, ELLEN ANN (LAADC CA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ANN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LAADC CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 KATELLA AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6500
Mailing Address - Country:US
Mailing Address - Phone:562-594-8444
Mailing Address - Fax:562-248-0477
Practice Address - Street 1:4281 KATELLA AVE STE 211
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6500
Practice Address - Country:US
Practice Address - Phone:562-594-8444
Practice Address - Fax:562-248-0477
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI04330815101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)