Provider Demographics
NPI:1437583184
Name:SHOFFNER, MISTY HOPE
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:HOPE
Last Name:SHOFFNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 S JONES BLVD OFC 206-B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3103
Mailing Address - Country:US
Mailing Address - Phone:702-496-1367
Mailing Address - Fax:888-688-9464
Practice Address - Street 1:2350 S JONES BLVD OFC 206-B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3103
Practice Address - Country:US
Practice Address - Phone:702-496-1367
Practice Address - Fax:888-688-9464
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLABAT052217103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1366730434Medicaid