MEDICARE: DR. JEFFERY THOMAS LOPEZ PHD

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	101Y00000X	Counselor	C4623	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306239330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY THOMAS LOPEZ PHD

Provider Business Mailing Address
First Line	:	1701 SHADOW WOOD DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-9746
Country	:	US
Telephone Number	:	503-708-6866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 SHADOW WOOD DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-9746
Country	:	US
Telephone Number	:	503-708-6866
Fax Number	:

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

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	03/06/2026

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