Provider Demographics
NPI:1649586728
Name:LOPEZ, RACHEL SALES (LAC, LCSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:SALES
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 MULLAN RD
Mailing Address - Street 2:APT B
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5615
Mailing Address - Country:US
Mailing Address - Phone:406-745-5555
Mailing Address - Fax:406-745-2627
Practice Address - Street 1:6445 MULLAN RD
Practice Address - Street 2:APT B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5615
Practice Address - Country:US
Practice Address - Phone:406-745-5555
Practice Address - Fax:406-745-2627
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT906101YA0400X
MT10311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1031OtherMT DEPT OF OCCUPATIONAL LICENSING
MT906OtherSTATE OF MONTANA