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Provider Information for 1285133256


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SHANE KEITH LOPEZ


Sex: Male

NPI: 1285133256
Last Updated: 2019-03-11
Certification Date:

Details

NameValue
NPI1285133256
Enumeration Date2018-02-06
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 115 KEATING DR
BELLE CHASSE, LA 70037-1629
United States

Phone: 504-393-5750 | Fax:318-251-4659
 
Primary Practice Address 115 KEATING DR
BELLE CHASSE, LA 70037
United States

Phone: 504-393-5750 | Fax:
 
Secondary Practice Address(es)

617 S TRENTON ST
RUSTON, LA 71270-5040
United States

Phone: 318-251-4659 | Fax:318-251-4659
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthLA6551