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1134844103
JESSE LOPEZ
SAINT LOUIS, MO
NPI
1134844103
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2022-10-11
Last Update Date
2022-10-11
Business Address
JESSE LOPEZ
1 JEFFERSON BARRACKS RD
SAINT LOUIS, MO 63125-4181
Phone number: 314-894-6598
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Mailing Address
JESSE LOPEZ
123 SHADOWBROOKE
TROY, IL 62294-3625
Phone number:
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