Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 180.009520 | IL |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor |
NPI | 1003179185 |
---|---|
Provider Name | Mr. Bryan James Hinman |
First Address | Normal, IL 61761-4713 |
Second Address | Bloomington, IL 61701-2814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 03/01/2020 |