Provider Demographics
NPI:1295921856
Name:HINES, SAMANTHA JUNE
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JUNE
Last Name:HINES
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 1:800 E 6TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3732
Mailing Address - Country:US
Mailing Address - Phone:405-372-1261
Mailing Address - Fax:405-377-5215
Practice Address - Street 1:800 E 6TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3732
Practice Address - Country:US
Practice Address - Phone:405-372-1261
Practice Address - Fax:405-377-5215
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator