Provider Demographics
NPI:1902082472
Name:TRI COUNTY HUMAN SERVICES CENTER INC
Entity Type:Organization
Organization Name:TRI COUNTY HUMAN SERVICES CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-282-1732
Mailing Address - Street 1:185 FALLBROOK ST
Mailing Address - Street 2:PO BOX 514
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-0514
Mailing Address - Country:US
Mailing Address - Phone:570-282-1732
Mailing Address - Fax:570-282-6808
Practice Address - Street 1:185 FALLBROOK ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-0514
Practice Address - Country:US
Practice Address - Phone:570-282-1732
Practice Address - Fax:570-282-6808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI COUNTY HUMAN SERVICES CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-15
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P002369Medicare UPIN
PA059746Medicare PIN