Provider Demographics
NPI:1194481184
Name:HINZE, SAMUEL (LMSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:HINZE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36275 N GANTZEL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7320
Mailing Address - Country:US
Mailing Address - Phone:480-590-7147
Mailing Address - Fax:
Practice Address - Street 1:36275 N GANTZEL RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7320
Practice Address - Country:US
Practice Address - Phone:480-590-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-13
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-19858104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1558994202OtherPRIVATE INSURANCE