Provider Demographics
NPI:1275214009
Name:TRAVERSE BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:TRAVERSE BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-209-1548
Mailing Address - Street 1:211 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1284
Mailing Address - Country:US
Mailing Address - Phone:606-209-1548
Mailing Address - Fax:606-770-6008
Practice Address - Street 1:211 8TH ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1284
Practice Address - Country:US
Practice Address - Phone:606-209-1548
Practice Address - Fax:606-770-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty