MEDICARE: TRI-COUNTY BEHAVIORAL SERVICES INC

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	MH8438	FL

General Provider Information

NPI Number	:	1942753785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-COUNTY BEHAVIORAL SERVICES INC

Provider Business Mailing Address
First Line	:	3219 SW 26TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2025
Country	:	US
Telephone Number	:	786-999-3296
Fax Number	:

Provider Business Practice Location Address
First Line	:	3219 SW 26TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2025
Country	:	US
Telephone Number	:	786-999-3296
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDUARDO PUENTE
Credential	:
Telephone Number	:	786-999-3296

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	07/28/2016

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