Basic Information
| Provider Information | |||||||||
| NPI: | 1508881525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPPER | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, LCDC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BIRGE | ||||||||
| OtherFirstName: | BARBARA | ||||||||
| OtherMiddleName: | WOODRUFF | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW, LCDC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1222 N MAIN AVE | ||||||||
| Address2: | SUITE 740 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782125712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102717411 | ||||||||
| FaxNumber: | 2102719414 | ||||||||
| Practice Location | |||||||||
| Address1: | 1222 N. MAIN | ||||||||
| Address2: | SUITE 740 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782125712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102717411 | ||||||||
| FaxNumber: | 2102719414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 03/18/2009 | ||||||||
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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 | 101YA0400X | 9313 | TX | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | S36271 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 150435901 | 05 | TX | MEDICAID |