Provider Demographics
NPI:1700509650
Name:HOFFMAN, NICHOLE (MS NCC LSC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MS NCC LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 NE LOGSDON RD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9278
Mailing Address - Country:US
Mailing Address - Phone:541-257-8689
Mailing Address - Fax:
Practice Address - Street 1:230 SW 3RD ST STE 311
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4652
Practice Address - Country:US
Practice Address - Phone:541-257-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR105446101YS0200X
ORR7981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool