MEDICARE: MRS. ALICIA MULVANEY HOOPER LCSW, LCDC

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	15403	TX
2	1041C0700X	Clinical Social Worker	64320	TX

General Provider Information

NPI Number	:	1699431320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICIA MULVANEY HOOPER LCSW, LCDC

Provider Business Mailing Address
First Line	:	7201 OLD DECATUR RD APT 402
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-7202
Country	:	US
Telephone Number	:	682-231-0157
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 S HENDERSON ST STE 460
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2155
Country	:	US
Telephone Number	:	503-802-9833
Fax Number	:

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

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	12/30/2021

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