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General NPI Number Information
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NPI Number | 1952893141
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Entity Type | Individual
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Provider Name | GEORGIA LOPEZ MS
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Gender | Female
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 5240 NE ELAM YOUNG PKWY STE 100
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City | HILLSBORO
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State | OR
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Zip | 97124-6438
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Country | US
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Telephone | 503-846-4555
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Fax | 503-846-3305
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Provider Business Mailing Address
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Address Line | 1171 NE 86TH WAY
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City | BEAVERTON
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State | OR
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Zip | 97006-6684
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Country | US
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Telephone | 971-246-5485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | OR
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