Healthcare Provider Details

I. General information

NPI: 1780452789
Provider Name (Legal Business Name): BROOKE HOEFERLE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 E VALLEY AUTO DR STE 104
MESA AZ
85206-4610
US

IV. Provider business mailing address

4115 E VALLEY AUTO DR STE 104
MESA AZ
85206-4610
US

V. Phone/Fax

Practice location:
  • Phone: 623-216-7320
  • Fax:
Mailing address:
  • Phone: 623-216-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-24179
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: