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General NPI Number Information
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NPI Number | 1003171620
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Entity Type | Individual
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Provider Name | BETHANEY LYNNE HOFFACKER MA, LMHC-QS
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Gender | Female
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 8280 COLLEGE PKWY STE 103
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City | FORT MYERS
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State | FL
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Zip | 33919-5122
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Country | US
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Telephone | 941-258-6944
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Fax |
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Provider Business Mailing Address
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Address Line | 15741 SUNNY CREST LN
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City | FORT MYERS
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State | FL
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Zip | 33905-2423
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Country | US
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Telephone | 941-258-9944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH12054
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH12054
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License Number State | FL
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