Provider Demographics
NPI:1124334610
Name:HOFFMAN, RENEE (LPC,BCBA)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LPC,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-0298
Mailing Address - Country:US
Mailing Address - Phone:817-408-6236
Mailing Address - Fax:
Practice Address - Street 1:8100 TIN TOP HWY
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76087-1717
Practice Address - Country:US
Practice Address - Phone:817-408-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14784101YP2500X
TX1-09-5283103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213579001Medicaid
TX89866LOtherBCBS