Healthcare Provider Details

I. General information

NPI: 1164485074
Provider Name (Legal Business Name): TRI COUNTY HUMAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 COMMERCE POINT DR
LAKELAND FL
33801-6880
US

IV. Provider business mailing address

2026 CRYSTAL WOOD DR
LAKELAND FL
33801-6884
US

V. Phone/Fax

Practice location:
  • Phone: 863-709-8543
  • Fax:
Mailing address:
  • Phone: 863-709-9392
  • Fax: 863-709-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BECKY RAZAIRE
Title or Position: ADMIN DIRECTOR
Credential:
Phone: 863-899-9538