Provider Demographics
NPI:1649063272
Name:HINES, MELISSA KAY
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KAY
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 1:14194 COUNTY ROAD 25
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-5060
Mailing Address - Country:US
Mailing Address - Phone:218-330-1365
Mailing Address - Fax:
Practice Address - Street 1:14194 COUNTY ROAD 25
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-5060
Practice Address - Country:US
Practice Address - Phone:218-330-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health