Healthcare Provider Details

I. General information

NPI: 1841731585
Provider Name (Legal Business Name): TRI-STATE THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E SHARON RD
CINCINNATI OH
45246-4736
US

IV. Provider business mailing address

460 E SHARON RD
CINCINNATI OH
45246-4736
US

V. Phone/Fax

Practice location:
  • Phone: 513-546-8752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE.0028343
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0028343
License Number StateOH

VIII. Authorized Official

Name: STEPHANY JONES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 513-546-8752