Provider Demographics
NPI:1083023394
Name:HINSHAW, CHRISSIE (EDS)
Entity Type:Individual
Prefix:
First Name:CHRISSIE
Middle Name:
Last Name:HINSHAW
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5360 EDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-4937
Mailing Address - Country:US
Mailing Address - Phone:740-816-3649
Mailing Address - Fax:
Practice Address - Street 1:5360 EDGEVIEW RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4937
Practice Address - Country:US
Practice Address - Phone:740-816-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3083801103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool