MEDICARE: LINDA JEAN HINES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	34005778A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	M300048347	OTHER	IN	MEDICARE UPIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12024387	OTHER	IN	CAQH

General Provider Information

NPI Number	:	1679614986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA JEAN HINES LCSW

Provider Business Mailing Address
First Line	:	10918 S SPRINGBORO RD
Second Line	:
City	:	BROOKSTON
State	:	IN
Zip	:	47923-8277
Country	:	US
Telephone Number	:	765-427-8019
Fax Number	:

Provider Business Practice Location Address
First Line	:	839 MAIN ST STE 551
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47901-2830
Country	:	US
Telephone Number	:	765-427-8019
Fax Number	:	765-347-2752

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	01/14/2022

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