Provider Demographics
NPI:1053683631
Name:HOOPER, AMANDA ANN (BACHELOR(EC)BHRS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ANN
Last Name:HOOPER
Suffix:
Gender:F
Credentials:BACHELOR(EC)BHRS
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:ANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BACHELOR DEGREE(EC)
Mailing Address - Street 1:31059 S 584 RD
Mailing Address - Street 2:
Mailing Address - City:BUNCH
Mailing Address - State:OK
Mailing Address - Zip Code:74931-2050
Mailing Address - Country:US
Mailing Address - Phone:918-457-4222
Mailing Address - Fax:
Practice Address - Street 1:31059 S 584 RD
Practice Address - Street 2:
Practice Address - City:BUNCH
Practice Address - State:OK
Practice Address - Zip Code:74931-2050
Practice Address - Country:US
Practice Address - Phone:918-457-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor