Healthcare Provider Details

I. General information

NPI: 1821056870
Provider Name (Legal Business Name): MELISSA T HOPPER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 E 22ND ST N BUILDING 800, SUITE 100
WICHITA KS
67226-2388
US

IV. Provider business mailing address

8100 E 22ND ST N BUILDING 800, SUITE 100
WICHITA KS
67226-2388
US

V. Phone/Fax

Practice location:
  • Phone: 316-683-4083
  • Fax: 316-689-8431
Mailing address:
  • Phone: 316-683-4083
  • Fax: 316-689-8431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1197
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: