Provider Demographics
NPI:1467706879
Name:TRI-COUNTY PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:TRI-COUNTY PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EYOB
Authorized Official - Middle Name:HAILU
Authorized Official - Last Name:TESSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-347-7705
Mailing Address - Street 1:557 GLOVER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2024
Mailing Address - Country:US
Mailing Address - Phone:334-347-7705
Mailing Address - Fax:334-347-7715
Practice Address - Street 1:557 GLOVER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2024
Practice Address - Country:US
Practice Address - Phone:334-347-7705
Practice Address - Fax:334-347-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty