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General NPI Number Information
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NPI Number | 1972647899
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY COUNSELING & LIFE SKILLS CENTER
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 11/03/2014
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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 | 941-429-3721
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Fax | 941-257-8395
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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 | 941-429-3721
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Fax | 941-257-8395
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Authorized Official
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Title or Position | CEO CLINICAL DIRECTOR
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Name | MR. THOMAS GEORGE GLAZA
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Credential | ED.D-LMHC- CAP
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Telephone | 941-876-3060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SR-58-AD-2079-01
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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