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General NPI Number Information
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NPI Number | 1902172216
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Entity Type | Organization
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Legal Business Name | BRAINARD W. HINES, PH.D, P.A.
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 5001 SW 74TH CT STE 104
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City | MIAMI
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State | FL
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Zip | 33155-4483
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Country | US
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Telephone | 305-804-4205
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Fax | 305-675-9254
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Provider Business Mailing Address
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Address Line | PO BOX 565508
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City | MIAMI
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State | FL
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Zip | 33256-5508
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Country | US
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Telephone | 305-804-4205
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Fax | 305-675-9254
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | BRAINARD W HINES
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Credential | LMHC, PH.D.
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Telephone | 305-804-4205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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