Healthcare Provider Details

I. General information

NPI: 1184069619
Provider Name (Legal Business Name): KELLY LAUREN HOFMANN MA, LMHC, CASAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 EDUCATION AVE
PUNTA GORDA FL
33950-6222
US

IV. Provider business mailing address

1237 SW 18TH AVE
CAPE CORAL FL
33991-2379
US

V. Phone/Fax

Practice location:
  • Phone: 941-639-8300
  • Fax:
Mailing address:
  • Phone: 516-698-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26032
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0116999
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: