Provider Demographics
NPI:1427209378
Name:TRINITY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:TRINITY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MFT
Authorized Official - Phone:541-245-2787
Mailing Address - Street 1:815 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6713
Mailing Address - Country:US
Mailing Address - Phone:541-245-2787
Mailing Address - Fax:541-899-3243
Practice Address - Street 1:815 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6713
Practice Address - Country:US
Practice Address - Phone:541-245-2787
Practice Address - Fax:541-899-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty