Healthcare Provider Details

I. General information

NPI: 1902073554
Provider Name (Legal Business Name): TRI-STATE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MILLIS AVE ST. MARY'S WARRICK
BOONVILLE IN
47601
US

IV. Provider business mailing address

1900 WATERS RIDGE DR
NEWBURGH IN
47630-8084
US

V. Phone/Fax

Practice location:
  • Phone: 812-962-2353
  • Fax: 812-962-0915
Mailing address:
  • Phone: 812-962-2353
  • Fax: 812-962-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01048619A
License Number StateIN

VIII. Authorized Official

Name: DR. ANJUM SHEHZAD ASHRAF
Title or Position: MEMBER
Credential: M.D
Phone: 812-962-2353