MEDICARE: LOUIS HOFFMAN, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 0002897	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497113336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUIS HOFFMAN, PHD

Provider Business Mailing Address
First Line	:	655 SOUTHPOINTE CT STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3859
Country	:	US
Telephone Number	:	719-510-8846
Fax Number	:	877-403-6856

Provider Business Practice Location Address
First Line	:	655 SOUTHPOINTE CT STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3859
Country	:	US
Telephone Number	:	719-510-8846
Fax Number	:	877-403-6856

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	DR. LOUIS HOFFMAN
Credential	:	PHD
Telephone Number	:	719-510-8846

Provider Enumeration Date	:	02/07/2016
Last Update Date	:	04/20/2017

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