Healthcare Provider Details

I. General information

NPI: 1477860609
Provider Name (Legal Business Name): HOFFMANN BURCHETT PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N WILLIAMSBURG DR SUITE F
BLOOMINGTON IL
61704-7706
US

IV. Provider business mailing address

205 N WILLIAMSBURG DR SUITE F
BLOOMINGTON IL
61704-7706
US

V. Phone/Fax

Practice location:
  • Phone: 309-830-8099
  • Fax: 309-454-5153
Mailing address:
  • Phone: 309-830-8099
  • Fax: 309-454-5153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0071006988
License Number StateIL

VIII. Authorized Official

Name: DR. CHRISTINA M. BURCHETT
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 309-830-8099