Provider Demographics
NPI:1912158668
Name:TERESA ELIAS-HOOPER, PSY. D LTD
Entity Type:Organization
Organization Name:TERESA ELIAS-HOOPER, PSY. D LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS-HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:601-856-0582
Mailing Address - Street 1:529 S. PEAR ORCHARD ROAD. SUITE B
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157
Mailing Address - Country:US
Mailing Address - Phone:601-856-0582
Mailing Address - Fax:
Practice Address - Street 1:529 S. PEAR ORCHARD ROAD. SUITE B
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-856-0582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS33543103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS436312198OtherBLUE CROSS BLUE SHIELD
MS00120519Medicaid
MS680000106Medicare PIN
MS00120519Medicaid