Basic Information
| Provider Information | |||||||||
| NPI: | 1316117708 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRI-COUNTY MENTAL HEALTH AND COUNSELING SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TCMHCS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405933682 | ||||||||
| FaxNumber: | 7405945642 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405933682 | ||||||||
| FaxNumber: | 7405945642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2008 | ||||||||
| LastUpdateDate: | 05/06/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WEIGLY | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | PATRICK | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7405945045 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 0206 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 2488722 | 05 | OH | MEDICAID | 1080 | 01 | OH | MACSIS PIN | OTHER |