Provider Demographics
NPI:1376362384
Name:HOOPER, CHRYSTEL (AMFT)
Entity type:Individual
Prefix:
First Name:CHRYSTEL
Middle Name:
Last Name:HOOPER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:CHRYSTEL
Other - Middle Name:
Other - Last Name:BLAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4564 GRANITE DOME RD
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-9456
Mailing Address - Country:US
Mailing Address - Phone:209-595-9536
Mailing Address - Fax:
Practice Address - Street 1:40298 JUNCTION DR STE B
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-8944
Practice Address - Country:US
Practice Address - Phone:559-642-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist