Provider Demographics
NPI:1952943466
Name:HOPPER, TRAVIS ALLYN
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:ALLYN
Last Name:HOPPER
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 1:214 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1418
Mailing Address - Country:US
Mailing Address - Phone:508-266-7077
Mailing Address - Fax:
Practice Address - Street 1:214 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-1418
Practice Address - Country:US
Practice Address - Phone:508-266-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst