Provider Demographics
NPI:1821432279
Name:TRI-COUNTY LIFE SKILLS CENTERS LLC
Entity Type:Organization
Organization Name:TRI-COUNTY LIFE SKILLS CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:GLAZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-268-0020
Mailing Address - Street 1:12543 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1446
Mailing Address - Country:US
Mailing Address - Phone:941-268-0020
Mailing Address - Fax:941-429-3778
Practice Address - Street 1:12543 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1446
Practice Address - Country:US
Practice Address - Phone:941-268-0020
Practice Address - Fax:941-429-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-28
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5146251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health