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1457610214
KEITH ALBERT LOPEZ
ANACONDA, MT
NPI
1457610214
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MT 14111)
Enumeration Date
2012-05-14
Last Update Date
2012-05-14
Business Address
-- KEITH ALBERT LOPEZ LAC
307 E PARK AVE SUITE 207B
ANACONDA, MT 59711-2320
Phone number: 406-563-7197
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Mailing Address
-- KEITH ALBERT LOPEZ LAC
T9 FORT MISSOULA
MISSOULA, MT 59804-7298
Phone number: 406-532-8400
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