Provider Demographics
NPI:1669782637
Name:HINES, PEGGY SUZANNE (MS ED, LPC)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:SUZANNE
Last Name:HINES
Suffix:
Gender:F
Credentials:MS ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5196
Mailing Address - Country:US
Mailing Address - Phone:360-923-7000
Mailing Address - Fax:360-923-7089
Practice Address - Street 1:711 BLAKE ST
Practice Address - Street 2:
Practice Address - City:BLANCHARDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53516-9756
Practice Address - Country:US
Practice Address - Phone:608-558-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61016892101YM0800X
WI4396125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional