Provider Demographics
NPI:1689921629
Name:TRI-COUNTY MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:TRI-COUNTY MENTAL HEALTH SERVICES
Other - Org Name:ACT TEAM
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNSELOR, REHABILITATION COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:CRC, LCPCC
Authorized Official - Phone:207-783-4692
Mailing Address - Street 1:230 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6578
Mailing Address - Country:US
Mailing Address - Phone:207-783-4692
Mailing Address - Fax:207-783-4694
Practice Address - Street 1:230 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6578
Practice Address - Country:US
Practice Address - Phone:207-783-4692
Practice Address - Fax:207-783-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3134261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health