Healthcare Provider Details

I. General information

NPI: 1821703612
Provider Name (Legal Business Name): HOPE THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 1/2 1ST ST NW STE 3
MOUNT VERNON IA
52314-1602
US

IV. Provider business mailing address

302 E 2ND AVE
LISBON IA
52253-9788
US

V. Phone/Fax

Practice location:
  • Phone: 319-535-3040
  • Fax:
Mailing address:
  • Phone: 714-661-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER RYAN HAGAN
Title or Position: DIRECTOR/PSYCHOLOGIST
Credential: PHD, LP, HSP
Phone: 319-535-3040