Provider Demographics
NPI:1477522282
Name:HOFFMAN, KURT M (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:M
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W MAIN ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1712
Mailing Address - Country:US
Mailing Address - Phone:260-418-1816
Mailing Address - Fax:877-418-1816
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:SUITE L
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1712
Practice Address - Country:US
Practice Address - Phone:260-418-1816
Practice Address - Fax:877-418-1816
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041663A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200802480Medicaid