=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417010117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL HAROLD FINK PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2006
-----------------------------------------------------
Last Update Date | 07/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1932 VIKING DR NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-2460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-281-6240
-----------------------------------------------------
Fax | 507-281-6247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 HARTZELL DR
-----------------------------------------------------
City | SHEPHERDSTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25443-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-870-4908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | LP1397
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------