Provider Demographics
NPI:1508863036
Name:HOPEWELL, CLIFFORD ALAN (PHD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:ALAN
Last Name:HOPEWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 UNIVERSITY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2168
Mailing Address - Country:US
Mailing Address - Phone:682-312-9820
Mailing Address - Fax:682-312-9821
Practice Address - Street 1:601 UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2168
Practice Address - Country:US
Practice Address - Phone:682-312-9820
Practice Address - Fax:682-312-9821
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21833103G00000X, 103TC0700X, 103T00000X
TX30391103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01554607OtherRAILROAD MEDICARE
TX131185416Medicaid
TX131185414Medicaid
TX131185407Medicaid
TX8EK468OtherBCBS
TXP01554607OtherRAILROAD MEDICARE