Healthcare Provider Details

I. General information

NPI: 1891286449
Provider Name (Legal Business Name): MELANIE DOREEN HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 COLORADO AVE
PUEBLO CO
81004-2005
US

IV. Provider business mailing address

327 COLORADO AVE
PUEBLO CO
81004-2005
US

V. Phone/Fax

Practice location:
  • Phone: 719-948-7120
  • Fax: 719-298-7144
Mailing address:
  • Phone: 719-948-7120
  • Fax: 719-298-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0004750
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: