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General NPI Number Information
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NPI Number | 1477860609
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Entity Type | Organization
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Legal Business Name | HOFFMANN BURCHETT PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 205 N WILLIAMSBURG DR SUITE F
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City | BLOOMINGTON
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State | IL
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Zip | 61704-7706
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Country | US
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Telephone | 309-830-8099
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Fax | 309-454-5153
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Provider Business Mailing Address
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Address Line | 205 N WILLIAMSBURG DR SUITE F
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City | BLOOMINGTON
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State | IL
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Zip | 61704-7706
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Country | US
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Telephone | 309-830-8099
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Fax | 309-454-5153
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. CHRISTINA M. BURCHETT
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Credential | PH.D.
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Telephone | 309-830-8099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0071006988
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License Number State | IL
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