Healthcare Provider Details

I. General information

NPI: 1538153226
Provider Name (Legal Business Name): TRACY LYNN HINZ LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WASHINGTON STREET
MONTICELLO MN
55362
US

IV. Provider business mailing address

2619 N 69TH ST
OMAHA NE
68104-3805
US

V. Phone/Fax

Practice location:
  • Phone: 763-271-5340
  • Fax: 763-271-5350
Mailing address:
  • Phone: 402-561-1206
  • Fax: 402-341-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2659
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: