Healthcare Provider Details

I. General information

NPI: 1386389567
Provider Name (Legal Business Name): AMY LYNN HOOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/02/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 SOUTH MARTIN LUTHER KING BLVD
FRESNO CA
93706-1622
US

IV. Provider business mailing address

1900 N GATEWAY BLVD # 100
FRESNO CA
93727-1622
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-4800
  • Fax:
Mailing address:
  • Phone: 559-251-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRADT
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: