Provider Demographics
NPI:1629511712
Name:TRYAD COUNSELING AND HEALING CENTER LLC
Entity Type:Organization
Organization Name:TRYAD COUNSELING AND HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR, MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:AEGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, LPC
Authorized Official - Phone:617-935-2245
Mailing Address - Street 1:16420 N THOMPSON PEAK PKWY UNIT 1122
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2169
Mailing Address - Country:US
Mailing Address - Phone:617-935-2245
Mailing Address - Fax:888-534-5731
Practice Address - Street 1:16420 N THOMPSON PEAK PKWY UNIT 1122
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2169
Practice Address - Country:US
Practice Address - Phone:617-935-2245
Practice Address - Fax:888-534-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9883101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty