Provider Demographics
NPI:1043856289
Name:TRINITY INTEGRATIVE CARE, LLC
Entity Type:Organization
Organization Name:TRINITY INTEGRATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-571-6555
Mailing Address - Street 1:6117 SUTHERLAND DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4654
Mailing Address - Country:US
Mailing Address - Phone:903-571-6555
Mailing Address - Fax:
Practice Address - Street 1:12863 COUNTY ROAD 192
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6417
Practice Address - Country:US
Practice Address - Phone:903-805-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)