Basic Information
| Provider Information | |||||||||
| NPI: | 1639187099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | GINNA | ||||||||
| MiddleName: | ALENE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MA, MFT, LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MARLOW | ||||||||
| OtherFirstName: | GINNA | ||||||||
| OtherMiddleName: | ALENE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2951 NW DIVISION ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970305292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039282999 | ||||||||
| FaxNumber: | 5036672580 | ||||||||
| Practice Location | |||||||||
| Address1: | 2951 NW DIVISION ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970305292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039282999 | ||||||||
| FaxNumber: | 5036672580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 02/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 42512 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | C2183 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.