Provider Demographics
NPI:1861852006
Name:LOPEZ, AMBER (BCBA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 EAGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-4137
Mailing Address - Country:US
Mailing Address - Phone:719-244-4299
Mailing Address - Fax:
Practice Address - Street 1:9299 EASTMAN PARK DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3318
Practice Address - Country:US
Practice Address - Phone:720-496-2605
Practice Address - Fax:720-496-2605
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-22147103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst