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NPI Code Detail

MEDICARE: DR. CAMRYN LOPEZ PSY.D.

MEDICARE:  DR. CAMRYN  LOPEZ  PSY.D.
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
1103TC0700XClinical Psychologist1483OK

General Provider Information

NPI Number : 1992518203
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAMRYN LOPEZ PSY.D.
Provider Business Mailing Address
First Line : 4107 N COUNCIL RD BLDG C
Second Line :
City : BETHANY
State : OK
Zip : 73008-3131
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4107 N COUNCIL RD BLDG C
Second Line :
City : BETHANY
State : OK
Zip : 73008-3131
Country : US
Telephone Number : 405-889-6366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2025
Last Update Date : 01/30/2025

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