Healthcare Provider Details

I. General information

NPI: 1255867156
Provider Name (Legal Business Name): GABRIEL M HOFKINS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 23RD ST
BOISE ID
83702-9100
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-1170
  • Fax: 208-466-5359
Mailing address:
  • Phone: 208-345-1170
  • Fax: 208-345-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-40452
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: