Provider Demographics
NPI:1821056870
Name:HOPPER, MELISSA T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:T
Last Name:HOPPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 E 22ND ST N
Mailing Address - Street 2:BUILDING 800, SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2388
Mailing Address - Country:US
Mailing Address - Phone:316-683-4083
Mailing Address - Fax:316-689-8431
Practice Address - Street 1:8100 E 22ND ST N
Practice Address - Street 2:BUILDING 800, SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2388
Practice Address - Country:US
Practice Address - Phone:316-683-4083
Practice Address - Fax:316-689-8431
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP1197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS106494OtherBC/BS
KS200252940AMedicaid
KS106494Medicare PIN
KS200252940AMedicaid