Healthcare Provider Details

I. General information

NPI: 1790344596
Provider Name (Legal Business Name): ALYCE MICHELLE HOPPLE PHD, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GIBAULT CARE, INC. 6401 S. US HWY 41
TERRE HAUTE IN
47802-4748
US

IV. Provider business mailing address

GIBAULT CARE, INC. 6401 S. US HWY 41
TERRE HAUTE IN
47802-4748
US

V. Phone/Fax

Practice location:
  • Phone: 812-299-1156
  • Fax: 812-299-0118
Mailing address:
  • Phone: 812-299-1156
  • Fax: 812-299-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: