Provider Demographics
NPI:1154682763
Name:TRI-COUNTY MENTAL HEALTH AND COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:TRI-COUNTY MENTAL HEALTH AND COUNSELING SERVICES, INC.
Other - Org Name:TCMH&CS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WEIGLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:740-592-3091
Mailing Address - Street 1:90 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2301
Mailing Address - Country:US
Mailing Address - Phone:740-592-3091
Mailing Address - Fax:
Practice Address - Street 1:90 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2301
Practice Address - Country:US
Practice Address - Phone:740-592-3091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH193200000X261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC040100OtherCOMMUNITY MENTAL HEALTH MEDICAID CONTRACT NUMBER
OHTR9170481OtherMEDICARE
OHTR9170483OtherMEDICARE
OH1018OtherMACSIS UPIN
OHTR9170482OtherMEDICARE
OH0200437Medicaid
OH1538148945OtherMH NPI