Healthcare Provider Details

I. General information

NPI: 1902983893
Provider Name (Legal Business Name): JAMES EDWIN TINKER LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N 31ST ST
COLORADO SPRINGS CO
80904-2016
US

IV. Provider business mailing address

511 N 31ST ST
COLORADO SPRINGS CO
80904-2016
US

V. Phone/Fax

Practice location:
  • Phone: 607-857-5152
  • Fax:
Mailing address:
  • Phone: 607-857-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number068549
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076217
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09931416
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: