Provider Demographics
NPI:1093734964
Name:PAUL TRITSOS ASSESSMENTS & COUNSELING SERVICES,LLC
Entity Type:Organization
Organization Name:PAUL TRITSOS ASSESSMENTS & COUNSELING SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRITSOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:850-215-6230
Mailing Address - Street 1:PO BOX 19135
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32417-1035
Mailing Address - Country:US
Mailing Address - Phone:850-215-6230
Mailing Address - Fax:850-215-6235
Practice Address - Street 1:2680 CHAPMAN DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4914
Practice Address - Country:US
Practice Address - Phone:850-215-6230
Practice Address - Fax:850-215-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL092500653OtherTRICARE
FL092500653OtherTRICARE
FLK9977Medicare PIN
FL=========OtherEIN
FLQ22515Medicare UPIN