1649586728 NPI number — MS. RACHEL SALES LOPEZ LAC, LCSW

Table of content: MS. RACHEL SALES LOPEZ LAC, LCSW (NPI 1649586728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649586728 NPI number — MS. RACHEL SALES LOPEZ LAC, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
RACHEL
Provider Middle Name:
SALES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LAC, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649586728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6445 MULLAN RD
Provider Second Line Business Mailing Address:
APT B
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59808-5615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-745-5555
Provider Business Mailing Address Fax Number:
406-745-2627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6445 MULLAN RD
Provider Second Line Business Practice Location Address:
APT B
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59808-5615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-745-5555
Provider Business Practice Location Address Fax Number:
406-745-2627
Provider Enumeration Date:
08/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  906 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 1031 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1031 . This is a "MT DEPT OF OCCUPATIONAL LICENSING" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 906 . This is a "STATE OF MONTANA" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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