1487872735 NPI number — LINDA L. HINES, PH.D., PC

Table of content: (NPI 1487872735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487872735 NPI number — LINDA L. HINES, PH.D., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA L. HINES, PH.D., PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAKESIDE PSYCHOLOGY & COUNSELING SRVCS.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487872735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2213 LAKESIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANNOCKBURN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-1265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-604-9441
Provider Business Mailing Address Fax Number:
847-604-9445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2213 LAKESIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANNOCKBURN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-1265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-604-9441
Provider Business Practice Location Address Fax Number:
847-604-9445
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HINES
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-604-9441

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180.0066190 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103G00000X , with the licence number: 071005286 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 071005286 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 071006069 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 071004060 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 071006544 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 149003472 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 036060099 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 337410 . This is a "LAKESIDE PSYCHOLOGY & COUNSELING SERVICES" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4919478 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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