Provider Demographics
NPI:1316557523
Name:TRI-CITIES DBT & TRAUMA
Entity Type:Organization
Organization Name:TRI-CITIES DBT & TRAUMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:989-906-0433
Mailing Address - Street 1:240 W MAIN ST STE 2600
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5191
Mailing Address - Country:US
Mailing Address - Phone:989-906-0433
Mailing Address - Fax:
Practice Address - Street 1:1807 SYLVAN LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6760
Practice Address - Country:US
Practice Address - Phone:989-906-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty