1821615147 NPI number — FLICK CONSULTATION GROUP PLLC

Table of content: (NPI 1821615147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821615147 NPI number — FLICK CONSULTATION GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLICK CONSULTATION GROUP PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821615147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 366
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINE ISLAND
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55963-0366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-216-3750
Provider Business Mailing Address Fax Number:
507-776-5036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 3RD AVENUE SE
Provider Second Line Business Practice Location Address:
SUITE 201-11
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-216-3750
Provider Business Practice Location Address Fax Number:
507-776-5036
Provider Enumeration Date:
07/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FLICK
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
OWNER/PROVIDER/MENTAL HEALTH PROFES
Authorized Official Telephone Number:
507-216-3750

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6843956 . This is a "MN TAX ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 14676192 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".




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