Provider Demographics
NPI:1891837118
Name:HINES, CECILIA KIM (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:KIM
Last Name:HINES
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17440 N TATUM BLVD
Mailing Address - Street 2:APT 209
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9346
Mailing Address - Country:US
Mailing Address - Phone:623-842-8240
Mailing Address - Fax:
Practice Address - Street 1:7301 N 58TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1893
Practice Address - Country:US
Practice Address - Phone:623-842-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ814097Medicaid