Provider Demographics
NPI:1407561541
Name:TRI-STATE AREA BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:TRI-STATE AREA BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:806-202-8681
Mailing Address - Street 1:1305 S HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-4412
Mailing Address - Country:US
Mailing Address - Phone:806-202-8681
Mailing Address - Fax:
Practice Address - Street 1:1305 S HARVARD ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-4412
Practice Address - Country:US
Practice Address - Phone:806-202-8681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty