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General NPI Number Information
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NPI Number | 1205285863
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Entity Type | Organization
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Legal Business Name | TRI COUNTY BEHAVIORAL HEALTHCARE
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Dates
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Enumeration Date | 06/05/2016
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Last Update Date | 06/05/2016
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Provider Practice Location Address
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Address Line | 245 FM 1488 RD 1131
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City | CONROE
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State | TX
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Zip | 77384-3983
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Country | US
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Telephone | 214-562-1083
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Fax |
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Provider Business Mailing Address
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Address Line | 245 FM 1488 RD 1131
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City | CONROE
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State | TX
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Zip | 77384-3983
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Country | US
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Telephone | 214-562-1083
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALLISON LEIGH BOOTH
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Credential | MA, LPC
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Telephone | 214-562-1083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 72350
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License Number State | TX
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