Healthcare Provider Details

I. General information

NPI: 1427652106
Provider Name (Legal Business Name): BRIDGETT HOPKINS T-LMAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 S HOLLAND LN
WICHITA KS
67209-2007
US

IV. Provider business mailing address

551 S HOLLAND LN
WICHITA KS
67209-2007
US

V. Phone/Fax

Practice location:
  • Phone: 316-796-5780
  • Fax:
Mailing address:
  • Phone: 316-796-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: