Basic Information
| Provider Information | |||||||||
| NPI: | 1700868676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINDMAN | ||||||||
| FirstName: | C | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 ESTILL ST | ||||||||
| Address2: | |||||||||
| City: | BEREA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404031742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599851415 | ||||||||
| FaxNumber: | 8599866752 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 ESTILL ST | ||||||||
| Address2: | |||||||||
| City: | BEREA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404031742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599851415 | ||||||||
| FaxNumber: | 8599866752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 12/21/2009 | ||||||||
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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 | 103TC0700X | 0152 | KY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.