Healthcare Provider Details

I. General information

NPI: 1043777048
Provider Name (Legal Business Name): JAMES RUDOLPH TUORILA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 DOCTORS PARK
SAINT CLOUD MN
56303-1207
US

IV. Provider business mailing address

103 DOCTORS PARK
SAINT CLOUD MN
56303-1207
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-4321
  • Fax: 320-281-3045
Mailing address:
  • Phone: 320-253-4321
  • Fax: 320-281-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JAMES RUDOLPH TUORILA
Title or Position: OWNER
Credential: PH.D.LP
Phone: 320-253-4321