=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740421254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY COUNSELING & EDUCATIONAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2009
-----------------------------------------------------
Last Update Date | 03/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15122 W CHICAGO ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48228-2357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-836-7667
-----------------------------------------------------
Fax | 313-836-7181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15122 W CHICAGO ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48228-2357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-836-7667
-----------------------------------------------------
Fax | 313-836-7181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MRS. TRACY DENICE MCCALL
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 313-778-4729
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 6801066493
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------