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General NPI Number Information
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NPI Number | 1821432279
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY LIFE SKILLS CENTERS LLC
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Dates
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Enumeration Date | 04/28/2013
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Last Update Date | 04/28/2013
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Provider Practice Location Address
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Address Line | 12543 TAMIAMI TRL S
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City | NORTH PORT
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State | FL
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Zip | 34287-1446
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Country | US
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Telephone | 941-268-0020
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Fax | 941-429-3778
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Provider Business Mailing Address
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Address Line | 12543 TAMIAMI TRL S
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City | NORTH PORT
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State | FL
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Zip | 34287-1446
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Country | US
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Telephone | 941-268-0020
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Fax | 941-429-3778
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS G GLAZA
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Credential | LMHC
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Telephone | 941-268-0020
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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 | MH 5146
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License Number State | FL
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