Provider Demographics
NPI:1578161725
Name:LOPEZ, JOSE SANTOS (LLMSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:SANTOS
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 PONDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-3681
Mailing Address - Country:US
Mailing Address - Phone:269-567-0828
Mailing Address - Fax:
Practice Address - Street 1:1331 PONDVIEW LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-3681
Practice Address - Country:US
Practice Address - Phone:269-567-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011021581041C0700X
IL1490297241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical