Provider Demographics
NPI:1639655293
Name:TRI-STAR BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:TRI-STAR BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TIGENOAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-340-9652
Mailing Address - Street 1:6 GRAMATAN AVE STE 606
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3208
Mailing Address - Country:US
Mailing Address - Phone:347-340-9652
Mailing Address - Fax:844-636-5521
Practice Address - Street 1:6 GRAMATAN AVE STE 606
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3208
Practice Address - Country:US
Practice Address - Phone:212-961-7299
Practice Address - Fax:844-636-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty