Provider Demographics
NPI:1710110317
Name:HINTON, MELVIN D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:D
Last Name:HINTON
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 1:492 RICHARD BROWN BLVD
Mailing Address - Street 2:
Mailing Address - City:VOLO
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5937
Mailing Address - Country:US
Mailing Address - Phone:224-338-0512
Mailing Address - Fax:
Practice Address - Street 1:492 RICHARD BROWN BLVD
Practice Address - Street 2:
Practice Address - City:VOLO
Practice Address - State:IL
Practice Address - Zip Code:60073-5937
Practice Address - Country:US
Practice Address - Phone:224-338-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007459103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist