Healthcare Provider Details

I. General information

NPI: 1700675246
Provider Name (Legal Business Name): ALEXIS SIMONE'-TARA HOFFMAN AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N DUESENBERG DR APT 8108
ONTARIO CA
91764-5938
US

IV. Provider business mailing address

950 N DUESENBERG DR APT 8108
ONTARIO CA
91764-5938
US

V. Phone/Fax

Practice location:
  • Phone: 909-294-0656
  • Fax:
Mailing address:
  • Phone: 909-294-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC19300
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT154836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: