Provider Demographics
NPI:1104606516
Name:HOPS, HOLLY BARRETT (PHD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:BARRETT
Last Name:HOPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:BARRETT
Other - Last Name:WALDRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10129 RIO GRANDE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-2344
Mailing Address - Country:US
Mailing Address - Phone:505-523-6313
Mailing Address - Fax:
Practice Address - Street 1:4233 MONTGOMERY BLVD NE STE J-100
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6749
Practice Address - Country:US
Practice Address - Phone:505-523-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1525103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent