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1750858858
JACK LOPEZ
BEND, OR
NPI
1750858858
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR 16-10-11)
Enumeration Date
2018-10-26
Last Update Date
2018-10-26
Business Address
JACK LOPEZ CADCII
155 NE REVERE AVE STE 150
BEND, OR 97701-4147
Phone number: 541-617-4544
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Mailing Address
JACK LOPEZ CADCII
155 NE REVERE AVE STE 150
BEND, OR 97701-4147
Phone number: 541-617-4544
Copy
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