MEDICARE: MRS. MIRACLE RAYE HOFF LPCC

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	101YP2500X	Professional Counselor	01726	MN
2	101YP2500X	Professional Counselor	537-9-15-05-254	ND

General Provider Information

NPI Number	:	1548308919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRACLE RAYE HOFF LPCC

Provider Business Mailing Address
First Line	:	4357 13TH AVE S STE 104
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-3381
Country	:	US
Telephone Number	:	701-478-4480
Fax Number	:	701-478-4481

Provider Business Practice Location Address
First Line	:	4357 13TH AVE S STE 104
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-7504
Country	:	US
Telephone Number	:	701-478-4480
Fax Number	:	701-478-4481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	11/22/2024

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