Provider Demographics
NPI:1235952862
Name:IMHOFF, JORDAN KYLE (LCMHC)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:KYLE
Last Name:IMHOFF
Suffix:
Gender:
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-9666
Mailing Address - Country:US
Mailing Address - Phone:931-244-0182
Mailing Address - Fax:
Practice Address - Street 1:832 BARNES RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655-9666
Practice Address - Country:US
Practice Address - Phone:931-244-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0136011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health