Healthcare Provider Details

I. General information

NPI: 1023521960
Provider Name (Legal Business Name): SPENCER HOFFMAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2938 NORTH AVE STE G
GRAND JUNCTION CO
81504-5797
US

IV. Provider business mailing address

2938 NORTH AVE STE G
GRAND JUNCTION CO
81504-5797
US

V. Phone/Fax

Practice location:
  • Phone: 970-245-1616
  • Fax:
Mailing address:
  • Phone: 970-245-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0013972
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: