Provider Demographics
NPI:1649524893
Name:LOPEZ, SUSANA MEZA (LPC)
Entity type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:MEZA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25938 GENESEE TRAIL RD UNIT 160
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5798
Mailing Address - Country:US
Mailing Address - Phone:720-212-8588
Mailing Address - Fax:
Practice Address - Street 1:25938 GENESEE TRAIL RD UNIT 220
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5798
Practice Address - Country:US
Practice Address - Phone:720-212-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 0011169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional