Provider Demographics
NPI:1568249324
Name:HOFFMAN, JARROD MICAH (LPC-MHSP (TEMP))
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:MICAH
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:LPC-MHSP (TEMP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 FERNDALE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-2707
Mailing Address - Country:US
Mailing Address - Phone:904-738-6778
Mailing Address - Fax:
Practice Address - Street 1:6363 POPLAR AVE STE 404
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4831
Practice Address - Country:US
Practice Address - Phone:901-860-4218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health