Provider Demographics
NPI:1649514910
Name:HOFSTETTER, JEAN M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:HOFSTETTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 LUCKY CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2238
Mailing Address - Country:US
Mailing Address - Phone:831-419-2478
Mailing Address - Fax:
Practice Address - Street 1:7514 LUCKY CLOVER LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-2238
Practice Address - Country:US
Practice Address - Phone:831-419-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1630106H00000X
CA28530103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist