Provider Demographics
NPI:1194225748
Name:TRIBELL, THOMAS R JR (TCADC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:TRIBELL
Suffix:JR
Gender:M
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-0550
Mailing Address - Country:US
Mailing Address - Phone:606-546-3805
Mailing Address - Fax:606-546-3903
Practice Address - Street 1:1909 KY 3439
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7201
Practice Address - Country:US
Practice Address - Phone:606-546-3805
Practice Address - Fax:606-546-3903
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYADCADT00225228101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)