Provider Demographics
NPI:1003171620
Name:HOFFACKER, BETHANEY LYNNE (MA, LMHC-QS)
Entity Type:Individual
Prefix:
First Name:BETHANEY
Middle Name:LYNNE
Last Name:HOFFACKER
Suffix:
Gender:F
Credentials:MA, LMHC-QS
Other - Prefix:
Other - First Name:BETHANEY
Other - Middle Name:LYNNE
Other - Last Name:GRAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:15741 SUNNY CREST LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-2423
Mailing Address - Country:US
Mailing Address - Phone:941-258-9944
Mailing Address - Fax:
Practice Address - Street 1:8280 COLLEGE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5122
Practice Address - Country:US
Practice Address - Phone:941-258-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12054101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor