Provider Demographics
NPI:1114472503
Name:HINES, AUDREY ANN (PLMHP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANN
Last Name:HINES
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 10TH AVE
Mailing Address - Street 2:POB 214
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-1611
Mailing Address - Country:US
Mailing Address - Phone:308-254-0737
Mailing Address - Fax:308-254-6375
Practice Address - Street 1:1023 10TH AVE
Practice Address - Street 2:POB 214
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1611
Practice Address - Country:US
Practice Address - Phone:308-254-0737
Practice Address - Fax:308-254-6375
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health