Healthcare Provider Details

I. General information

NPI: 1780115782
Provider Name (Legal Business Name): BRIAN HOOPER M.DIV., PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 HARDING ROAD, SUITE 221
NASHVILLE TN
37205-2119
US

IV. Provider business mailing address

4525 HARDING ROAD, SUITE 221
NASHVILLE TN
37205-2119
US

V. Phone/Fax

Practice location:
  • Phone: 615-485-5923
  • Fax:
Mailing address:
  • Phone: 615-485-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberCPC #54
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: