Basic Information
| Provider Information | |||||||||
| NPI: | 1386012706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPPERSTAD | ||||||||
| FirstName: | CHELSIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1707 CEYLON ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800115237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202991221 | ||||||||
| FaxNumber: | 3039338216 | ||||||||
| Practice Location | |||||||||
| Address1: | 8120 SHERIDAN BLVD STE 207 | ||||||||
| Address2: | |||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800036104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207297910 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2015 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 9924087 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 4577069 | 05 | CO | MEDICAID |