Healthcare Provider Details

I. General information

NPI: 1568249324
Provider Name (Legal Business Name): JARROD MICAH HOFFMAN LPC-MHSP (TEMP)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 POPLAR AVE STE 404
MEMPHIS TN
38119-4831
US

IV. Provider business mailing address

4400 FERNDALE RD
MEMPHIS TN
38122-2707
US

V. Phone/Fax

Practice location:
  • Phone: 901-860-4218
  • Fax:
Mailing address:
  • Phone: 904-738-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6626
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: