Provider Demographics
NPI:1588711675
Name:HOXWORTH, BRET A (LLP)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:A
Last Name:HOXWORTH
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-2559
Mailing Address - Country:US
Mailing Address - Phone:517-852-4362
Mailing Address - Fax:
Practice Address - Street 1:126 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333
Practice Address - Country:US
Practice Address - Phone:269-205-2402
Practice Address - Fax:269-205-2402
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012161103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling