MEDICARE: AVERY HOPPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	12913	CA

General Provider Information

NPI Number	:	1477392363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY HOPPE

Provider Business Mailing Address
First Line	:	302 N EL CAMINO REAL STE 216
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4778
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 N EL CAMINO REAL STE 216
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4778
Country	:	US
Telephone Number	:	949-478-4815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/21/2024

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Directions to “ AVERY HOPPE ” Practice Location

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