Basic Information
| Provider Information | |||||||||
| NPI: | 1225263387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINTON | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | ERIC | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | MA, CAAC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HINTON | ||||||||
| OtherFirstName: | KYLE | ||||||||
| OtherMiddleName: | ERIC | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | SR. | ||||||||
| OtherCredential: | MA, CAAC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4475 SPRINGMONT | ||||||||
| Address2: | |||||||||
| City: | KENTWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495125375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165406393 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4475 SPRINGMONT DR SE | ||||||||
| Address2: | |||||||||
| City: | KENTWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495125375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165406393 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2009 | ||||||||
| LastUpdateDate: | 05/19/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.