Provider Demographics
NPI:1538404231
Name:HOPPER, DOUGLAS (LMFT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:HOPPER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BROADWAY APT D104
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-5630
Mailing Address - Country:US
Mailing Address - Phone:801-425-1882
Mailing Address - Fax:
Practice Address - Street 1:25 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1840
Practice Address - Country:US
Practice Address - Phone:801-663-6656
Practice Address - Fax:801-298-2024
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8049997-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist