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General NPI Number Information
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NPI Number | 1265987069
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Entity Type | Organization
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Legal Business Name | JORDAN HOFMANN, LLC
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 1300 S LOCUST ST STE F
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City | GRAND ISLAND
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State | NE
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Zip | 68801-8200
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Country | US
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Telephone | 308-398-0350
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Fax | 308-398-0351
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Provider Business Mailing Address
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Address Line | 1300 S LOCUST ST STE F
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City | GRAND ISLAND
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State | NE
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Zip | 68801-8200
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Country | US
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Telephone | 308-398-0350
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Fax | 308-398-0351
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN M HOFMANN
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Credential | MA, LMHP
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Telephone | 402-460-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4663
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License Number State | NE
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