Healthcare Provider Details

I. General information

NPI: 1003171620
Provider Name (Legal Business Name): BETHANEY LYNNE HOFFACKER MA, LMHC-QS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANEY LYNNE GRAF MA

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 COLLEGE PKWY STE 103
FORT MYERS FL
33919-5122
US

IV. Provider business mailing address

15741 SUNNY CREST LN
FORT MYERS FL
33905-2423
US

V. Phone/Fax

Practice location:
  • Phone: 941-258-6944
  • Fax:
Mailing address:
  • Phone: 941-258-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH12054
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: