Provider Demographics
NPI:1952775405
Name:HOOPER, CRYSTAL S
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:S
Last Name:HOOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 NW CENTRAL AVENUE SUITE N
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422
Mailing Address - Country:US
Mailing Address - Phone:985-284-7077
Mailing Address - Fax:985-284-7077
Practice Address - Street 1:112 OZONE DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6018
Practice Address - Country:US
Practice Address - Phone:985-351-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA454875652Medicaid