Provider Demographics
NPI:1629164082
Name:TRI-COUNTY MENTAL HEALTH
Entity Type:Organization
Organization Name:TRI-COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-755-0036
Mailing Address - Street 1:49 WILLIAM ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4882
Mailing Address - Country:US
Mailing Address - Phone:207-317-0471
Mailing Address - Fax:
Practice Address - Street 1:1155 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5025
Practice Address - Country:US
Practice Address - Phone:207-783-9141
Practice Address - Fax:207-755-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER050690364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty