MEDICARE: TRI-STATE THERAPEUTIC SERVICES

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	E.0028343	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	E.0028343	OH

General Provider Information

NPI Number	:	1841731585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	460 E SHARON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-4736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 E SHARON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-4736
Country	:	US
Telephone Number	:	513-546-8752
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	STEPHANY JONES
Credential	:
Telephone Number	:	513-546-8752

Provider Enumeration Date	:	03/14/2017
Last Update Date	:	03/23/2017

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Directions to “TRI-STATE THERAPEUTIC SERVICES ” Practice Location

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