Provider Demographics
NPI:1598934028
Name:HOFACKER, PAUL WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILLIAM
Last Name:HOFACKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1024
Mailing Address - Street 2:LAKE COUNTY BEHAVIORAL HEALTH
Mailing Address - City:LUCERNE
Mailing Address - State:CA
Mailing Address - Zip Code:95458
Mailing Address - Country:US
Mailing Address - Phone:707-274-9101
Mailing Address - Fax:707-274-9192
Practice Address - Street 1:6302 THIRTEENTH AVENUE
Practice Address - Street 2:LAKE COUNTY BEHAVIORAL HEALTH
Practice Address - City:LUCERNE
Practice Address - State:CA
Practice Address - Zip Code:95458
Practice Address - Country:US
Practice Address - Phone:707-274-9101
Practice Address - Fax:707-274-9192
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5258103T00000X, 103TC0700X
CAPSY25568103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical