Healthcare Provider Details

I. General information

NPI: 1467937573
Provider Name (Legal Business Name): MANDY JO HOFLAND LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANDY JO HERRMANN

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CENTER AVE STE 3
MOORHEAD MN
56560-1972
US

IV. Provider business mailing address

725 CENTER AVE STE 3
MOORHEAD MN
56560-1972
US

V. Phone/Fax

Practice location:
  • Phone: 218-366-6162
  • Fax:
Mailing address:
  • Phone: 218-366-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1832
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1329-10-1-23-566
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: