Provider Demographics
NPI:1407620321
Name:MINK, TIMOTHY HOWARD (MS, LADAC II)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:HOWARD
Last Name:MINK
Suffix:
Gender:M
Credentials:MS, LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11618 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-3910
Mailing Address - Country:US
Mailing Address - Phone:865-505-2813
Mailing Address - Fax:
Practice Address - Street 1:11618 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-3910
Practice Address - Country:US
Practice Address - Phone:865-505-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1417101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)