Provider Demographics
NPI:1467469429
Name:LOPEZ, BRIAN (PHD BCBA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PHD BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 WASHINGTON ST NE
Mailing Address - Street 2:STE A1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1846
Mailing Address - Country:US
Mailing Address - Phone:505-828-3837
Mailing Address - Fax:877-828-1550
Practice Address - Street 1:8500 WASHINGTON ST NE
Practice Address - Street 2:STE A1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1846
Practice Address - Country:US
Practice Address - Phone:505-828-3837
Practice Address - Fax:877-828-1550
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0877103T00000X
NM1-16-22964103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst