Healthcare Provider Details

I. General information

NPI: 1679807465
Provider Name (Legal Business Name): JENNIFER LYNN HOFFMAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 BRUNSWICK RD STE 9
GRASS VALLEY CA
95945-9544
US

IV. Provider business mailing address

10385 ALTA ST
GRASS VALLEY CA
95945-6130
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-0976
  • Fax: 530-274-8866
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC44842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: