Provider Demographics
NPI:1811547490
Name:HINTZ-LYON, NIKOLE MARIE
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:MARIE
Last Name:HINTZ-LYON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16913 W TASHA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1548
Mailing Address - Country:US
Mailing Address - Phone:623-640-2088
Mailing Address - Fax:
Practice Address - Street 1:14961 W BELL RD STE A125
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3200
Practice Address - Country:US
Practice Address - Phone:623-640-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty