Healthcare Provider Details

I. General information

NPI: 1487143046
Provider Name (Legal Business Name): KORISSA HOOVER BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MEADOWOOD DR APT C1
CARBONDALE CO
81623-9201
US

IV. Provider business mailing address

PO BOX 1732
CARBONDALE CO
81623-4732
US

V. Phone/Fax

Practice location:
  • Phone: 970-216-4066
  • Fax:
Mailing address:
  • Phone: 970-216-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0001949
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0020552
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: