Provider Demographics
NPI:1891248027
Name:FLICK, BRIAN KENNETH (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KENNETH
Last Name:FLICK
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-23
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN220831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical