Provider Demographics
NPI:1679661110
Name:HOOPES, JERRY ORRELL JR
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:ORRELL
Last Name:HOOPES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552
Mailing Address - Country:US
Mailing Address - Phone:928-428-1970
Mailing Address - Fax:
Practice Address - Street 1:3210 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-5630
Practice Address - Country:US
Practice Address - Phone:928-428-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7468453-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical