Provider Demographics
NPI:1346626538
Name:HINES, JACOB (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:HINES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 N ARLINGTON HEIGHTS RD STE F
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7701
Mailing Address - Country:US
Mailing Address - Phone:847-577-4530
Mailing Address - Fax:847-577-4306
Practice Address - Street 1:3375 N ARLINGTON HEIGHTS RD STE F
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-577-4530
Practice Address - Fax:847-577-4306
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical