Healthcare Provider Details

I. General information

NPI: 1467704775
Provider Name (Legal Business Name): LAURA C. LOPACH PH.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 SOUTH AVE W STE 400
MISSOULA MT
59801-6521
US

IV. Provider business mailing address

1821 SOUTH AVE W STE 400
MISSOULA MT
59801-6521
US

V. Phone/Fax

Practice location:
  • Phone: 406-209-8905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-PSY-2844
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: