Provider Demographics
NPI:1619684461
Name:TRIPLE H RANCH LLC
Entity Type:Organization
Organization Name:TRIPLE H RANCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANBUSKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:228-283-5005
Mailing Address - Street 1:7205 HUMPHREY RD
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-7806
Mailing Address - Country:US
Mailing Address - Phone:228-283-5005
Mailing Address - Fax:
Practice Address - Street 1:7205 HUMPHREY RD
Practice Address - Street 2:
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-7806
Practice Address - Country:US
Practice Address - Phone:228-283-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty