Provider Demographics
NPI:1790879377
Name:HINZ, BYRON (LCSW, SAC)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:HINZ
Suffix:
Gender:M
Credentials:LCSW, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6785
Mailing Address - Country:US
Mailing Address - Phone:715-848-4600
Mailing Address - Fax:715-845-5398
Practice Address - Street 1:1225 LANGLADE ROAD
Practice Address - Street 2:
Practice Address - City:ANITGO
Practice Address - State:WI
Practice Address - Zip Code:54409
Practice Address - Country:US
Practice Address - Phone:715-623-2394
Practice Address - Fax:715-627-4194
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4239-1231041C0700X
WI11735-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4239-123OtherSTATE LICENSE
WI11735-131OtherSTATE LICENSE