Doctor Name: | DR. PAUL WILLIAM HOFACKER |
NPI Number: | 1598934028 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PY5258 |
Business Practice Address: | 6302 Thirteenth Avenue Lake County Behavioral Health Lucerne, CA - 95458 |
Business Phone Number: | 7072749101 |
Business Fax Number: | 7072749192 |
Mailing Address: | P.o. Box 1024, Lake County Behavioral Health LUCERNE |
State: | CA |
Postal Code: | 95458 |
Phone Number: | 7072749101 |
Fax Number: | 7072749192 |
NPI Enumeration Date: | 02/28/2008 |
NPI Last Update Date: | 09/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PY5258 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |