Provider Demographics
NPI:1770700890
Name:LOPEZ, BILLI JEAN (LISW-S, LMT)
Entity type:Individual
Prefix:
First Name:BILLI
Middle Name:JEAN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LISW-S, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 HIGLEY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2328
Mailing Address - Country:US
Mailing Address - Phone:419-704-6520
Mailing Address - Fax:
Practice Address - Street 1:5151 MONROE ST STE 250E
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3469
Practice Address - Country:US
Practice Address - Phone:419-684-2178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13980225700000X, 225700000X
OHI.2002497-SUPV1041C0700X
OHS.1501207104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0295931Medicaid
OH203361378-00OtherBWC