Individual provider Active NPI

Carlos G Lopez

  • Addiction (Substance Use Disorder) Counselor
  • Port Orchard, WA
National Provider Identifier
1083182885
Registry record updated Nov 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CO60613823 Issued in WA
Practice address
1415 Lumsden Rd
Port Orchard, WA 98367-9179
Phone
(360) 881-7878
Fax
(360) 876-0713
NPI assigned
Nov 9, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CO60613823 WA Primary

Addresses

Primary practice location

1415 Lumsden Rd
Port Orchard, WA 98367-9179

Mailing address

1415 Lumsden Rd
Port Orchard, WA 98367-9179
Phone (360) 881-7878

Other identifiers 1

IdentifierTypeStateIssuer
CO60613823OtherWAWASHINGTON STATE DEPARTMENT OF HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CO60613823WAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
West Sound Treatment Center Addiction (Substance Use Disorder) Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541721600000",
    "number": "1083182885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 LUMSDEN RD",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983679179",
            "telephone_number": "360-881-7878",
            "fax_number": "360-876-0713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 LUMSDEN RD",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983679179",
            "telephone_number": "360-881-7878",
            "fax_number": "360-876-0713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "CARLOS",
        "middle_name": "G",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-09",
        "last_updated": "2018-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60613823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
            "identifier": "CO60613823",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.