Provider Demographics
NPI:1669607206
Name:TRI-COUNTY TBI ASSOCIATES, LLC
Entity type:Organization
Organization Name:TRI-COUNTY TBI ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-519-1221
Mailing Address - Street 1:410 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1420
Mailing Address - Country:US
Mailing Address - Phone:315-519-1221
Mailing Address - Fax:315-519-1204
Practice Address - Street 1:410 STATE ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1420
Practice Address - Country:US
Practice Address - Phone:315-519-1221
Practice Address - Fax:315-519-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health