Provider Demographics
NPI:1649082215
Name:HOPSON, JACK
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:HOPSON
Suffix:
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 1:4006 N KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2834
Mailing Address - Country:US
Mailing Address - Phone:317-775-7382
Mailing Address - Fax:317-342-3429
Practice Address - Street 1:4006 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2834
Practice Address - Country:US
Practice Address - Phone:317-775-7382
Practice Address - Fax:317-342-3429
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician