MEDICARE: TRINITY BEHAVIORAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1487774675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	1350 PARK DR
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3205
Country	:	US
Telephone Number	:	985-624-7956
Fax Number	:	985-624-9841

Provider Business Practice Location Address
First Line	:	1350 PARK DR
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3205
Country	:	US
Telephone Number	:	985-624-7956
Fax Number	:	985-624-9841

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. VAN GERRY MORRIS
Credential	:
Telephone Number	:	985-624-7956

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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