Healthcare Provider Details

I. General information

NPI: 1245019165
Provider Name (Legal Business Name): HOFFMAN THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MADISON AVE
MANKATO MN
56001-6109
US

IV. Provider business mailing address

721 MULLIGAN ST
MANKATO MN
56001-2318
US

V. Phone/Fax

Practice location:
  • Phone: 507-327-9738
  • Fax:
Mailing address:
  • Phone: 507-327-9738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JASON ROBERT HOFFMAN
Title or Position: LPCC LADC NCC
Credential: LPCC LADC NCC
Phone: 507-327-9738