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General NPI Number Information
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NPI Number | 1750959698
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Entity Type | Organization
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Legal Business Name | ATLAST MENTAL HEALTH COUNSELING, LLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 101 N ST. PAUL AVE
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City | FULDA
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State | MN
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Zip | 56131
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Country | US
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Telephone | 605-360-5690
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Fax |
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Provider Business Mailing Address
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Address Line | 201 PINE DRIVE
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City | LUVERNE
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State | MN
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Zip | 56156
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Country | US
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Telephone | 605-360-5690
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/OWNER
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Name | LORI ANN TINGLE
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Credential | MALP
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Telephone | 605-360-5690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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