Healthcare Provider Details

I. General information

NPI: 1871896050
Provider Name (Legal Business Name): ELLEN R HOFFMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25550 CHAGRIN BLVD SUITE 200
BEACHWOOD OH
44122-5638
US

IV. Provider business mailing address

25550 CHAGRIN BLVD SUITE 200
BEACHWOOD OH
44122-5638
US

V. Phone/Fax

Practice location:
  • Phone: 216-765-0500
  • Fax: 216-765-0521
Mailing address:
  • Phone: 216-765-0500
  • Fax: 216-765-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0900616
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: