Healthcare Provider Details

I. General information

NPI: 1396883179
Provider Name (Legal Business Name): BARBARA BRAYTON HINES MS MAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W COLLEGE WELLNESS COUNSELING CENTER SUITE 815
APPLETON WI
54911
US

IV. Provider business mailing address

103 W COLLEGE WELLNESS COUNSELING CENTER SUITE 815
APPLETON WI
54911
US

V. Phone/Fax

Practice location:
  • Phone: 920-733-1992
  • Fax: 920-733-1866
Mailing address:
  • Phone: 920-733-1992
  • Fax: 920-733-1866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2474125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number184124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: