Healthcare Provider Details

I. General information

NPI: 1972925881
Provider Name (Legal Business Name): TRIAD BEHAVIOR SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2014
Last Update Date: 01/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 WASHINGTON AVE UNIT D
CARNEGIE PA
15106-2848
US

IV. Provider business mailing address

552 WASHINGTON AVE UNIT D
CARNEGIE PA
15106-2848
US

V. Phone/Fax

Practice location:
  • Phone: 412-429-1908
  • Fax: 412-429-0800
Mailing address:
  • Phone: 412-429-1908
  • Fax: 412-429-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH000214
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH000214
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberBH000214
License Number StatePA

VIII. Authorized Official

Name: HEATHER BETTS
Title or Position: OWNER
Credential:
Phone: 412-429-1908