Provider Demographics
NPI:1316075641
Name:HINSDELL, CAROLYN MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARIE
Last Name:HINSDELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:HINSDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2114 SE WASHINGTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-7255
Mailing Address - Country:US
Mailing Address - Phone:918-939-9024
Mailing Address - Fax:
Practice Address - Street 1:2114 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7254
Practice Address - Country:US
Practice Address - Phone:918-876-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42448106H00000X
OK994106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK43-1236557Medicaid