Provider Demographics
NPI:1356452163
Name:TINIUS, TIMOTHY PAUL (PHD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PAUL
Last Name:TINIUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N BENTON DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1575
Mailing Address - Country:US
Mailing Address - Phone:320-654-9311
Mailing Address - Fax:320-654-9248
Practice Address - Street 1:225 N BENTON DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1575
Practice Address - Country:US
Practice Address - Phone:320-654-9311
Practice Address - Fax:320-654-9248
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0251103G00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-21170OtherMEDICA PIN
MN075J1TI 075J6TIOtherBCBS PROVIDER PIN