Provider Demographics
NPI:1548308919
Name:HOFF, MIRACLE RAYE (LPCC)
Entity type:Individual
Prefix:MRS
First Name:MIRACLE
Middle Name:RAYE
Last Name:HOFF
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MIRACLE
Other - Middle Name:RAYE
Other - Last Name:HAASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4357 13TH AVE S STE 104
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3381
Mailing Address - Country:US
Mailing Address - Phone:701-478-4480
Mailing Address - Fax:701-478-4481
Practice Address - Street 1:4357 13TH AVE S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7504
Practice Address - Country:US
Practice Address - Phone:701-478-4480
Practice Address - Fax:701-478-4481
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01726101YP2500X
ND537-9-15-05-254101YP2500X, 101YP2500X
ND1507101YA0400X
MN00959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health