Provider Demographics
NPI:1962463505
Name:HINMAN, MARY (MS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:HINMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:BAUSCH
Other - Last Name:HINMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:511 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3608
Mailing Address - Country:US
Mailing Address - Phone:541-683-3355
Mailing Address - Fax:
Practice Address - Street 1:511 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3608
Practice Address - Country:US
Practice Address - Phone:541-683-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0480101YP2500X
OR5030103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional