Provider Demographics
NPI:1326375296
Name:TRINITY BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:TRINITY BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PH D
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:JR
Authorized Official - Credentials:CLINICAL PSYCHOLOGIS
Authorized Official - Phone:727-848-0840
Mailing Address - Street 1:5413 GEORGE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4101
Mailing Address - Country:US
Mailing Address - Phone:727-848-0840
Mailing Address - Fax:727-255-5075
Practice Address - Street 1:5413 GEORGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4101
Practice Address - Country:US
Practice Address - Phone:727-848-0840
Practice Address - Fax:727-255-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6915103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CX565AMedicare PIN