Provider Demographics
NPI:1285311332
Name:HOOPER, NATHANIEL LEVI (LLMSW)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:LEVI
Last Name:HOOPER
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6453 QUAIL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-9679
Mailing Address - Country:US
Mailing Address - Phone:517-204-1282
Mailing Address - Fax:
Practice Address - Street 1:3800 HERITAGE AVE STE A2
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2871
Practice Address - Country:US
Practice Address - Phone:517-204-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511161211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical