Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | MH12054 | FL |
Y | 101YM0800X | Mental Health Counselor | MH12054 | FL |
NPI | 1003171620 |
---|---|
Provider Name | Bethaney Lynne Hoffacker |
First Address | Fort Myers, FL 33905-2423 |
Second Address | Fort Myers, FL 33919-5122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 14/01/2022 |