Provider Demographics
NPI:1700863206
Name:HOFMAN, GARY L (EDD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:HOFMAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S LOUISE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3124
Mailing Address - Country:US
Mailing Address - Phone:605-334-7713
Mailing Address - Fax:605-334-5348
Practice Address - Street 1:4300 S LOUISE AVE STE 201
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3124
Practice Address - Country:US
Practice Address - Phone:605-334-7713
Practice Address - Fax:605-334-5348
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSDCCDCIII1051148101YA0400X
SDSDLPCMH2032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575260Medicaid
SD4998512OtherBCBS