Healthcare Provider Details

I. General information

NPI: 1205765955
Provider Name (Legal Business Name): NATHAN LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 W DARTMOUTH AVE STE 305
DENVER CO
80227-5517
US

IV. Provider business mailing address

302 ELLENDALE ST
CASTLE ROCK CO
80104-8733
US

V. Phone/Fax

Practice location:
  • Phone: 432-664-0157
  • Fax:
Mailing address:
  • Phone: 432-664-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: