Provider Demographics
NPI:1316181704
Name:MINK, TARIN L (LSW)
Entity Type:Individual
Prefix:
First Name:TARIN
Middle Name:L
Last Name:MINK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 SR 160
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8409
Mailing Address - Country:US
Mailing Address - Phone:740-446-5500
Mailing Address - Fax:740-441-4402
Practice Address - Street 1:3086 SR 160
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8409
Practice Address - Country:US
Practice Address - Phone:740-446-5500
Practice Address - Fax:740-441-4402
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0030291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200820Medicaid