MEDICARE: MS. AMY HOFFMAN LCDC III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	111077	OH

General Provider Information

NPI Number	:	1437580917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY HOFFMAN LCDC III

Provider Business Mailing Address
First Line	:	10268 SHORT RD
Second Line	:
City	:	HARRISON
State	:	OH
Zip	:	45030-1849
Country	:	US
Telephone Number	:	513-508-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 S COLLEGE AVE
Second Line	:
City	:	OXFORD
State	:	OH
Zip	:	45056-1738
Country	:	US
Telephone Number	:	513-523-4149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/09/2013

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