Provider Demographics
NPI:1275313488
Name:TINOCO, YULIAN A (MA, LLC)
Entity Type:Individual
Prefix:MR
First Name:YULIAN
Middle Name:A
Last Name:TINOCO
Suffix:
Gender:M
Credentials:MA, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1603
Mailing Address - Country:US
Mailing Address - Phone:269-471-5968
Mailing Address - Fax:
Practice Address - Street 1:640 SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1603
Practice Address - Country:US
Practice Address - Phone:269-471-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional