Provider Demographics
NPI:1245341007
Name:LOPEZ, ELIZABETH (LSCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GUINEVERE DR
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-8843
Mailing Address - Country:US
Mailing Address - Phone:785-762-4210
Mailing Address - Fax:785-762-6876
Practice Address - Street 1:132 N EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3314
Practice Address - Country:US
Practice Address - Phone:785-762-4210
Practice Address - Fax:785-762-6876
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical