MEDICARE: JULIA CHRISTINE LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180011106	IL
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1770865578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA CHRISTINE LOPEZ

Provider Business Mailing Address
First Line	:	710 N 8TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-6324
Country	:	US
Telephone Number	:	217-525-1064
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W WHITE OAKS DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-6410
Country	:	US
Telephone Number	:	303-214-8886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	06/02/2026

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