Provider Demographics
NPI:1356815179
Name:TRI-CITY COUNSELING, LCSW, PLLC
Entity Type:Organization
Organization Name:TRI-CITY COUNSELING, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CASAC
Authorized Official - Phone:315-717-7307
Mailing Address - Street 1:3042 NY HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-2529
Mailing Address - Country:US
Mailing Address - Phone:315-717-7307
Mailing Address - Fax:518-620-2258
Practice Address - Street 1:12 CENTURY HILL DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2123
Practice Address - Country:US
Practice Address - Phone:518-620-3116
Practice Address - Fax:518-620-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty