Provider Demographics
NPI:1245968858
Name:HOFFMAN, TANNER (EDS, NCSP, ABSNP)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:EDS, NCSP, ABSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 COUGAR AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8498
Mailing Address - Country:US
Mailing Address - Phone:307-587-4273
Mailing Address - Fax:
Practice Address - Street 1:2901 COUGAR AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8498
Practice Address - Country:US
Practice Address - Phone:307-587-4273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPTSB103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool