Healthcare Provider Details

I. General information

NPI: 1649747395
Provider Name (Legal Business Name): DR. TINA HOOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 W PIERCE ST
CARLSBAD NM
88220-3514
US

IV. Provider business mailing address

PO BOX 3141
CARLSBAD NM
88221-3141
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5552
  • Fax: 575-725-5552
Mailing address:
  • Phone: 575-725-5552
  • Fax: 575-725-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number37666
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number37666
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number37666
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number37666
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2024-1155
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number37666
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: