Provider Demographics
NPI:1366749749
Name:HINZE PSYCHOLOGICAL SERVICES, PC
Entity type:Organization
Organization Name:HINZE PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:HINZE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-614-3795
Mailing Address - Street 1:PO BOX 642507
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-8150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16542 VENTURA BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2005
Practice Address - Country:US
Practice Address - Phone:818-788-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-19
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty