1790344596 NPI number — DR. ALYCE MICHELLE HOPPLE PHD, NCSP

Table of content: DR. ALYCE MICHELLE HOPPLE PHD, NCSP (NPI 1790344596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790344596 NPI number — DR. ALYCE MICHELLE HOPPLE PHD, NCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOPPLE
Provider First Name:
ALYCE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, NCSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790344596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GIBAULT CARE, INC.
Provider Second Line Business Mailing Address:
6401 S. US HWY 41
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47802-4748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-299-1156
Provider Business Mailing Address Fax Number:
812-299-0118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GIBAULT CARE, INC.
Provider Second Line Business Practice Location Address:
6401 S. US HWY 41
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-4748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-299-1156
Provider Business Practice Location Address Fax Number:
812-299-0118
Provider Enumeration Date:
06/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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