Provider Demographics
NPI:1427135755
Name:HOPSON, GUS K (MA,LLP,LPC)
Entity type:Individual
Prefix:
First Name:GUS
Middle Name:K
Last Name:HOPSON
Suffix:
Gender:M
Credentials:MA,LLP,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 ARDMORE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2748
Mailing Address - Country:US
Mailing Address - Phone:616-299-0284
Mailing Address - Fax:866-595-6304
Practice Address - Street 1:4215 W PASADENA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-2374
Practice Address - Country:US
Practice Address - Phone:616-299-0284
Practice Address - Fax:866-595-6304
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6401007100101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1712452Medicaid
MI20378Medicare UPIN
MI750910904Medicare UPIN
MI1712452Medicaid
MI20351Medicare UPIN
MI20366Medicare UPIN
MI20386Medicare UPIN
MI750910910Medicare UPIN
MIOP22320Medicare ID - Type Unspecified
MI750910902Medicare UPIN
MI750910903Medicare UPIN