Provider Demographics
NPI:1699431320
Name:HOOPER, ALICIA MULVANEY (LCSW, LCDC)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MULVANEY
Last Name:HOOPER
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 OLD DECATUR RD APT 402
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7202
Mailing Address - Country:US
Mailing Address - Phone:682-231-0157
Mailing Address - Fax:
Practice Address - Street 1:500 S HENDERSON ST STE 460
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2155
Practice Address - Country:US
Practice Address - Phone:503-802-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15403101YA0400X
TX643201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty