Healthcare Provider Details

I. General information

NPI: 1386118313
Provider Name (Legal Business Name): MATTHEW SCOTT HOFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2019
Last Update Date: 01/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 ROMA AVE NW
ALBUQUERQUE NM
87104-1243
US

IV. Provider business mailing address

1012 CENTRAL AVE SW
ALBUQUERQUE NM
87102-2905
US

V. Phone/Fax

Practice location:
  • Phone: 802-922-4896
  • Fax:
Mailing address:
  • Phone: 505-835-5943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: