Provider Demographics
NPI:1396824066
Name:HINES, MARTHA A (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:HINES
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3114
Mailing Address - Country:US
Mailing Address - Phone:206-325-7294
Mailing Address - Fax:
Practice Address - Street 1:506 2ND AVE STE 1400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2329
Practice Address - Country:US
Practice Address - Phone:425-330-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional