Healthcare Provider Details

I. General information

NPI: 1740100023
Provider Name (Legal Business Name): JACEY LAUREN HOPPES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 N FM 3083 RD W STE 100
CONROE TX
77304-4606
US

IV. Provider business mailing address

16334 HAYES LOOP
MONTGOMERY TX
77316-3303
US

V. Phone/Fax

Practice location:
  • Phone: 832-702-1099
  • Fax:
Mailing address:
  • Phone: 832-401-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number103065
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: