Provider Demographics
NPI:1891844973
Name:TRICARE BEHAVORIAL HEALTH LLC
Entity Type:Organization
Organization Name:TRICARE BEHAVORIAL HEALTH LLC
Other - Org Name:STRESS CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-239-2190
Mailing Address - Street 1:4024 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2028
Mailing Address - Country:US
Mailing Address - Phone:423-239-4638
Mailing Address - Fax:423-239-5249
Practice Address - Street 1:4024 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2028
Practice Address - Country:US
Practice Address - Phone:423-239-4638
Practice Address - Fax:423-239-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL 2(14)M2-106-1632251S00000X
TNL 2(14)M2-106-1633251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNL 2(14)M2-106-1633OtherTRICARE BRISTOL LICENSE
TNL 2(14)M2-106-1632OtherSTRESS CARE ASSOC LICENSE
TN3902223Medicare PIN
TNL 2(14)M2-106-1633OtherTRICARE BRISTOL LICENSE
TN444606Medicare Oscar/Certification