Tri-State Area Behavioral Health LLC
Organization Active NPI Professional Counselor · Perryton, TX
NPI 1407561541 · NPPES record last updated Jan 23, 2023
Key facts
- NPI
- 1407561541
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- Legal business name
- TRI-STATE AREA BEHAVIORAL HEALTH LLC
- Practice address
- 1305 S Harvard St
Perryton, TX 79070-4412 - Phone
- (806) 202-8681
- NPI assigned
- Jan 23, 2023
- Organization subpart
- No
Authorized official
- Name
- Kathi Boren, LPC
- Title
- Sole Member
- Phone
- (806) 202-8681
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240202000258 | TX | Part B Supplier - Clinic/Group Practice | 8628421963 |
Receives reassigned benefits from 1 practitioner Practice locations: Perryton, TX |
National Provider Directory
Locations
514 S Main St
Perryton, TX 79070
Phone (806) 202-8681
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | Yes |
Addresses
Primary practice location
1305 S Harvard St
Perryton, TX 79070-4412
Mailing address
1305 S Harvard St
Perryton, TX 79070-4412
Phone (806) 202-8681
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.