Provider Demographics
NPI:1265987069
Name:JORDAN HOFMANN, LLC
Entity type:Organization
Organization Name:JORDAN HOFMANN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHP
Authorized Official - Phone:402-460-0600
Mailing Address - Street 1:1300 S LOCUST ST STE F
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-8200
Mailing Address - Country:US
Mailing Address - Phone:308-398-0350
Mailing Address - Fax:308-398-0351
Practice Address - Street 1:1300 S LOCUST ST STE F
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-8200
Practice Address - Country:US
Practice Address - Phone:308-398-0350
Practice Address - Fax:308-398-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty