Provider Demographics
NPI:1538906037
Name:HINES-BRANDT, EMMA LOUISE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:LOUISE
Last Name:HINES-BRANDT
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:OE
Other - Middle Name:LOUISE
Other - Last Name:HINES-BRANDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:241 5TH ST APT 11
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-5634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13765 VINTAGE DR SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7391
Practice Address - Country:US
Practice Address - Phone:253-970-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician