Healthcare Provider Details

I. General information

NPI: 1154638617
Provider Name (Legal Business Name): MICHAEL HOFFMAN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2010
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SE REED MARKET RD STE 205
BEND OR
97702-2237
US

IV. Provider business mailing address

429 NE FRANKLIN AVE
BEND OR
97701-4918
US

V. Phone/Fax

Practice location:
  • Phone: 541-639-6246
  • Fax:
Mailing address:
  • Phone: 541-639-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 60113465
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6074
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MICHAEL ROBERT HOFFMAN
Title or Position: OWNER
Credential: MSW, LCSW, LICSW
Phone: 541-639-6246