Healthcare Provider Details

I. General information

NPI: 1669161154
Provider Name (Legal Business Name): NATHAN JOHN HOFFMAN MA, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 ROGERS DR STE 100
ROGERS MN
55374-4721
US

IV. Provider business mailing address

21000 ROGERS DR STE 100
ROGERS MN
55374-4721
US

V. Phone/Fax

Practice location:
  • Phone: 763-291-5505
  • Fax: 763-657-0819
Mailing address:
  • Phone: 763-291-5505
  • Fax: 763-657-0819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3808
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: