Healthcare Provider Details

I. General information

NPI: 1841843984
Provider Name (Legal Business Name): JORDAN ALEXANDER HOFFMAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 12TH AVE W STE 2B
COLUMBIA FALLS MT
59912-3866
US

IV. Provider business mailing address

5217 NEWCASTLE LN
CALABASAS CA
91302-3118
US

V. Phone/Fax

Practice location:
  • Phone: 406-208-8312
  • Fax:
Mailing address:
  • Phone: 818-642-7495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-PSY-LIC-3751
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: