Healthcare Provider Details

I. General information

NPI: 1902567779
Provider Name (Legal Business Name): SUSAN SHAUNA HOFFMAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24359 WALNUT ST STE A
NEWHALL CA
91321-6101
US

IV. Provider business mailing address

24359 WALNUT ST STE A
NEWHALL CA
91321-6101
US

V. Phone/Fax

Practice location:
  • Phone: 661-714-5137
  • Fax:
Mailing address:
  • Phone: 661-714-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: