Provider Demographics
NPI:1477099166
Name:TINKER, KATHLEEN BROOKS (ACMHCE)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BROOKS
Last Name:TINKER
Suffix:
Gender:F
Credentials:ACMHCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 RED BUD CIR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6813
Mailing Address - Country:US
Mailing Address - Phone:719-822-6638
Mailing Address - Fax:
Practice Address - Street 1:301 N 200 E STE 2C
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3040
Practice Address - Country:US
Practice Address - Phone:719-822-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11651246-6010101YM0800X
COLPCC.0014854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health