Provider Demographics
NPI:1053773010
Name:HOFFMAN, BREANNA MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MICHELLE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2086 130TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-7009
Mailing Address - Country:US
Mailing Address - Phone:763-670-3970
Mailing Address - Fax:
Practice Address - Street 1:4255 PHEASANT RIDGE DR NE STE 412
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5066
Practice Address - Country:US
Practice Address - Phone:763-703-3755
Practice Address - Fax:763-703-3725
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist