Healthcare Provider Details

I. General information

NPI: 1891332862
Provider Name (Legal Business Name): MARISSA HINDS CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 E MILL PLAIN BLVD
VANCOUVER WA
98661
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 206-764-0502
  • Fax: 206-764-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number60864739
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: