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General NPI Number Information
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NPI Number | 1073395414
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Entity Type | Organization
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Legal Business Name | TIN CUP COUNSELING AND CONSULTATION PLLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 33254 STATE HIGHWAY 28
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City | STARBUCK
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State | MN
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Zip | 56381-2029
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Country | US
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Telephone | 320-200-5028
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 BROADWAY ST STE 240
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2664
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Country | US
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Telephone | 320-200-5028
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. COLTER COMBELLICK
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Credential | MSW, LICSW
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Telephone | 320-200-5028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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