Provider Demographics
NPI:1821615147
Name:FLICK CONSULTATION GROUP PLLC
Entity Type:Organization
Organization Name:FLICK CONSULTATION GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:FLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:507-356-2184
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55963-0366
Mailing Address - Country:US
Mailing Address - Phone:507-356-2184
Mailing Address - Fax:507-356-2185
Practice Address - Street 1:231 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PINE ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55963-7659
Practice Address - Country:US
Practice Address - Phone:507-356-2184
Practice Address - Fax:507-356-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14676192OtherCAQH
MN6843956OtherMN TAX ID