Healthcare Provider Details

I. General information

NPI: 1679093421
Provider Name (Legal Business Name): MARK HOFFMAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 S MILWAUKEE AVE STE 104
LIBERTYVILLE IL
60048-3759
US

IV. Provider business mailing address

2035 N FREMONT ST
CHICAGO IL
60614-4311
US

V. Phone/Fax

Practice location:
  • Phone: 847-748-0385
  • Fax:
Mailing address:
  • Phone: 312-283-5700
  • Fax: 312-940-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178004042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: