Provider Demographics
NPI:1194466193
Name:MOTT-HOFFMAN, TAMMY MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:MOTT-HOFFMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W11251 SUNRISE RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:WI
Mailing Address - Zip Code:54128-9013
Mailing Address - Country:US
Mailing Address - Phone:715-853-7651
Mailing Address - Fax:
Practice Address - Street 1:324 S ANDREWS ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2406
Practice Address - Country:US
Practice Address - Phone:715-524-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7895-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7895-125OtherSTATE LPC LICENSE