Basic Information
| Provider Information | |||||||||
| NPI: | 1932219821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRI-COUNTY BEHAVIORAL HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3067 | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365216100 | ||||||||
| FaxNumber: | 9367602898 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 E LOOP 336 NORTH | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365216100 | ||||||||
| FaxNumber: | 9367602898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 04/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | STANDLEY | ||||||||
| AuthorizedOfficialFirstName: | BEVERLYS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | REIMBURSEMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9366216100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 001007218 | 01 | TX | HCS | OTHER |