Healthcare Provider Details

I. General information

NPI: 1063322022
Provider Name (Legal Business Name): MATTHEW LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 N WEBER ST STE 205
COLORADO SPRINGS CO
80903-1058
US

IV. Provider business mailing address

731 N WEBER ST STE 205
COLORADO SPRINGS CO
80903-1058
US

V. Phone/Fax

Practice location:
  • Phone: 719-362-0558
  • Fax: 719-316-5658
Mailing address:
  • Phone: 719-362-0558
  • Fax: 719-316-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: