Provider Demographics
NPI:1871662775
Name:LOPEZ, DENNIS (BA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 1ST
Mailing Address - Street 2:MENTAL HEALTH RESOURCES INC
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130
Mailing Address - Country:US
Mailing Address - Phone:505-359-1221
Mailing Address - Fax:505-359-1075
Practice Address - Street 1:300 E 1ST
Practice Address - Street 2:MENTAL HEALTH RESOURCES INC
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130
Practice Address - Country:US
Practice Address - Phone:505-359-1221
Practice Address - Fax:505-359-1075
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator