MEDICARE: TRICO CLINICAL SERVICES, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		MD

General Provider Information

NPI Number	:	1255758405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICO CLINICAL SERVICES, LTD

Provider Business Mailing Address
First Line	:	PO BOX 826
Second Line	:
City	:	LEXINGTON PARK
State	:	MD
Zip	:	20653-0826
Country	:	US
Telephone Number	:	301-862-4961
Fax Number	:	301-862-5554

Provider Business Practice Location Address
First Line	:	5606 DOWER HOUSE RD
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3604
Country	:	US
Telephone Number	:	301-862-4961
Fax Number	:	301-862-5554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM E ARICK
Credential	:	LCPC,NCC,ACS
Telephone Number	:	301-862-4961

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	03/26/2014

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