Healthcare Provider Details

I. General information

NPI: 1629511712
Provider Name (Legal Business Name): TRYAD COUNSELING AND HEALING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15804 E BRITTLEBUSH LN
FOUNTAIN HILLS AZ
85268-3183
US

IV. Provider business mailing address

15804 E BRITTLEBUSH LN
FOUNTAIN HILLS AZ
85268-3183
US

V. Phone/Fax

Practice location:
  • Phone: 617-935-2245
  • Fax: 617-546-1333
Mailing address:
  • Phone: 617-935-2245
  • Fax: 617-546-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9883
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRINE A AEGERTER
Title or Position: SOLE PROPRIETOR, MANAGER
Credential: M.S, LMHC, LPC
Phone: 617-935-2245