=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497054902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHWORKS CSH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2011
-----------------------------------------------------
Last Update Date | 11/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 WILSHIRE DR STE 202
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48084-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-667-8885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41011 CAYENNE DR.
-----------------------------------------------------
City | STERLING HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48314-3918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-667-8885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. CINDY HINDO
-----------------------------------------------------
Credential | PHD, LP
-----------------------------------------------------
Telephone | 248-667-8885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6301014573
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------