Healthcare Provider Details

I. General information

NPI: 1598393118
Provider Name (Legal Business Name): LAWRENCE EDWARD HINER III PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LARRY HINER PSYD

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 MINERAL SPRINGS DR
KYLE TX
78640-2308
US

IV. Provider business mailing address

272 MINERAL SPRINGS DR
KYLE TX
78640-2308
US

V. Phone/Fax

Practice location:
  • Phone: 916-709-0737
  • Fax:
Mailing address:
  • Phone: 916-709-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: