1154682763 NPI number — TRI-COUNTY MENTAL HEALTH AND COUNSELING SERVICES, INC.

Table of content: (NPI 1154682763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154682763 NPI number — TRI-COUNTY MENTAL HEALTH AND COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-COUNTY MENTAL HEALTH AND COUNSELING SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154682763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45701-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-592-3091
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-592-3091
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WEIGLY
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
740-592-3091

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  193200000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MC040100 . This is a "COMMUNITY MENTAL HEALTH MEDICAID CONTRACT NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: TR9170481 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: TR9170483 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1018 . This is a "MACSIS UPIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: TR9170482 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0200437 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1538148945 . This is a "MH NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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