MEDICARE: KORISSA HOOVER BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0001949	CO
2	101YP2500X	Professional Counselor	LPC.0020552	CO

General Provider Information

NPI Number	:	1487143046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORISSA HOOVER BA

Provider Business Mailing Address
First Line	:	PO BOX 1732
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-4732
Country	:	US
Telephone Number	:	970-216-4066
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 MEADOWOOD DR APT C1
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-9201
Country	:	US
Telephone Number	:	970-216-4066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	04/19/2026

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Directions to “ KORISSA HOOVER BA” Practice Location

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