Basic Information
| Provider Information | |||||||||
| NPI: | 1245463470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPPE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LPC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5620 SW GREEN OAKS BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760171160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175694393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5620 SW GREEN OAKS BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760171160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172052706 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2009 | ||||||||
| LastUpdateDate: | 05/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 63179 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 205084101 | 05 | TX | MEDICAID |