Healthcare Provider Details

I. General information

NPI: 1629164082
Provider Name (Legal Business Name): TRI-COUNTY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 LISBON ST
LEWISTON ME
04240-5025
US

IV. Provider business mailing address

49 WILLIAM ST APT 2
PORTLAND ME
04103-4882
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-9141
  • Fax: 207-755-0045
Mailing address:
  • Phone: 207-317-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR050690
License Number StateME

VIII. Authorized Official

Name: MR. DALE S. HUTCHINSON
Title or Position: PATIENT ACCOUNTS MGR
Credential:
Phone: 207-755-0036