Provider Demographics
NPI:1073614129
Name:THREE RIVERS FAMILY THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:THREE RIVERS FAMILY THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA ECKERT-MCCOY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:785-823-6333
Mailing Address - Street 1:645 E IRON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2697
Mailing Address - Country:US
Mailing Address - Phone:785-823-6333
Mailing Address - Fax:785-823-6381
Practice Address - Street 1:645 E IRON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2697
Practice Address - Country:US
Practice Address - Phone:785-823-6333
Practice Address - Fax:785-823-6381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS09241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS070558OtherBCBS PROVIDER NUMBER
KS070558OtherBCBS PROVIDER NUMBER