Provider Demographics
NPI:1871577387
Name:HOFFMANN, MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785-0432
Mailing Address - Country:US
Mailing Address - Phone:417-276-3380
Mailing Address - Fax:417-276-1146
Practice Address - Street 1:104 E DAVIS
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785
Practice Address - Country:US
Practice Address - Phone:417-276-3380
Practice Address - Fax:417-276-1146
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004037106101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4994496601Medicaid