Provider Demographics
NPI:1215189907
Name:TRI-S COUNSELING & EDUCATION
Entity Type:Organization
Organization Name:TRI-S COUNSELING & EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LITTLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCDC, CCM
Authorized Official - Phone:817-920-9321
Mailing Address - Street 1:4200 SOUTH FWY
Mailing Address - Street 2:SUITE 424
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-1400
Mailing Address - Country:US
Mailing Address - Phone:817-920-9321
Mailing Address - Fax:817-920-9336
Practice Address - Street 1:4200 SOUTH FWY
Practice Address - Street 2:SUITE 424
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-1400
Practice Address - Country:US
Practice Address - Phone:817-920-9321
Practice Address - Fax:817-920-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177933201Medicaid
TX612159Medicare PIN