MEDICARE: MR. RUEBEN LOPEZ LLPC

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	6401015211	MI

General Provider Information

NPI Number	:	1053860916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUEBEN LOPEZ LLPC

Provider Business Mailing Address
First Line	:	4867 E BELTLINE AVE NE STE 4
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9787
Country	:	US
Telephone Number	:	616-292-4594
Fax Number	:

Provider Business Practice Location Address
First Line	:	4867 E BELTLINE AVE NE STE 4
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9787
Country	:	US
Telephone Number	:	616-292-4594
Fax Number	:

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

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	03/19/2024

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