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General NPI Number Information
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NPI Number | 1689993602
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Entity Type | Organization
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Legal Business Name | TRINITEAM, INC.
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 07/05/2010
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Provider Practice Location Address
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Address Line | 202 GRAHAM AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54701-3632
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Country | US
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Telephone | 715-836-8106
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Fax | 715-836-8104
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Provider Business Mailing Address
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Address Line | 202 GRAHAM AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54701-3632
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Country | US
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Telephone | 715-836-8106
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Fax | 715-836-8104
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT PEITZMAN
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Credential |
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Telephone | 715-836-8106
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1936
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License Number State | WI
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