Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LPCC.0016427 | CO |
NPI | 1063981025 |
---|---|
Provider Name | Ms. Juchia Crystal Lopez |
First Address | Colorado Springs, CO 80909-2857 |
Second Address | Colorado Springs, CO 80909-3558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2018 |
Last Update Date | 20/11/2018 |