Provider Demographics
NPI:1215768734
Name:DAVID LOPEZ MARRIAGE AND FAMILY THERAPIST INC
Entity type:Organization
Organization Name:DAVID LOPEZ MARRIAGE AND FAMILY THERAPIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-626-8118
Mailing Address - Street 1:PO BOX 578534
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-8534
Mailing Address - Country:US
Mailing Address - Phone:209-626-8118
Mailing Address - Fax:
Practice Address - Street 1:3600 SISK RD # 5A-16
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0535
Practice Address - Country:US
Practice Address - Phone:209-626-8118
Practice Address - Fax:209-502-7035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty