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134 W Holum St Deforest WI 53532-1108 | |
| (608) 620-5126 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 134 W Holum St, Deforest, Wisconsin |
| Authorized Official Name and Position | Amy Lynn Hoffmann (PROVIDER/OWNER/MEMBER) |
| Authorized Official Contact | 6083475551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
134 W Holum St Deforest WI 53532-1108 Ph: (608) 620-5126 | 134 W Holum St Deforest WI 53532-1108 Ph: (608) 620-5126 |
| NPI Number | 1558977991 |
|---|---|
| Provider Enumeration Date | 09/21/2020 |
| Last Update Date | 08/17/2023 |
| Certification Date | 08/17/2023 |
| Medicare PECOS PAC ID | 4789039686 |
|---|---|
| Medicare Enrollment ID | O20231012002933 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558977991 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Amy L Hoffmann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235426206 PECOS PAC ID: 4183036551 Enrollment ID: I20201209002865 |
| Provider Name | Kristen Emily Golat |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003385865 PECOS PAC ID: 6204207103 Enrollment ID: I20230131002082 |
| Provider Name | Brenda Beverly Hunter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962410092 PECOS PAC ID: 4183168941 Enrollment ID: I20240703001957 |
Newlife Behavioral Health, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 4133 Painted Arabian Run, Deforest, WI 53532 Phone: 608-707-7880 |