Basic Information
| Provider Information | |||||||||
| NPI: | 1801436100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINDERER | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | PAUL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15127 S 73RD AVE STE G | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604623425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088455500 | ||||||||
| FaxNumber: | 7088455505 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 LATHROP AVE STE LL95 | ||||||||
| Address2: | |||||||||
| City: | RIVER FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603051875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088455500 | ||||||||
| FaxNumber: | 7088455505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2020 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 166001349 | IL | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.