Basic Information
| Provider Information | |||||||||
| NPI: | 1588042428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | WENDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 E 11TH AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416831641 | ||||||||
| FaxNumber: | 5416813294 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 E 11TH AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416831641 | ||||||||
| FaxNumber: | 5416813294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2015 | ||||||||
| LastUpdateDate: | 12/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.