Healthcare Provider Details

I. General information

NPI: 1134300825
Provider Name (Legal Business Name): HOFFMAN PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W MAIN ST SUITE L
FORT WAYNE IN
46802-1712
US

IV. Provider business mailing address

130 W MAIN ST SUITE L
FORT WAYNE IN
46802-1712
US

V. Phone/Fax

Practice location:
  • Phone: 260-418-1816
  • Fax: 877-418-1816
Mailing address:
  • Phone: 260-418-1816
  • Fax: 877-418-1816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KURT M. HOFFMAN
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PSY.D., HSPP
Phone: 260-418-1816