Provider Demographics
NPI:1750528048
Name:HOOPER, HOSSON DAVID (MS)
Entity type:Individual
Prefix:MR
First Name:HOSSON
Middle Name:DAVID
Last Name:HOOPER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15071
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95851-0071
Mailing Address - Country:US
Mailing Address - Phone:916-719-7771
Mailing Address - Fax:
Practice Address - Street 1:7000 LINCOLNSHIRE DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-875-9969
Practice Address - Fax:916-925-6469
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79118106H00000X
CAMFTI45065101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANONEOtherNONE