Provider Demographics
NPI:1265934301
Name:HOPP, BENJAMIN RICHARDSON (ASSOCIATE MFT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RICHARDSON
Last Name:HOPP
Suffix:
Gender:M
Credentials:ASSOCIATE MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-3222
Mailing Address - Country:US
Mailing Address - Phone:209-531-2088
Mailing Address - Fax:
Practice Address - Street 1:2935 4TH ST
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-3222
Practice Address - Country:US
Practice Address - Phone:209-531-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101492106H00000X
CA140440106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist