Provider Demographics
NPI:1972647899
Name:TRI-COUNTY COUNSELING & LIFE SKILLS CENTER
Entity Type:Organization
Organization Name:TRI-COUNTY COUNSELING & LIFE SKILLS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GLAZA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD-LMHC- CAP
Authorized Official - Phone:941-876-3060
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:941-429-3721
Mailing Address - Fax:941-257-8395
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:941-429-3721
Practice Address - Fax:941-257-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSR-58-AD-2079-01101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty