Healthcare Provider Details

I. General information

NPI: 1427383066
Provider Name (Legal Business Name): JILL ANN HOFER MED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 CAMBRIDGE DR
YUKON OK
73099-4912
US

IV. Provider business mailing address

1024 CAMBRIDGE DR
YUKON OK
73099-4912
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-7223
  • Fax:
Mailing address:
  • Phone: 405-604-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4209
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: