Provider Demographics
NPI:1861914350
Name:TRINITY BEHAVIORAL MEDICINE, PLLC
Entity type:Organization
Organization Name:TRINITY BEHAVIORAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:423-464-6272
Mailing Address - Street 1:4363 OCOEE ST N STE 3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4894
Mailing Address - Country:US
Mailing Address - Phone:423-464-6272
Mailing Address - Fax:423-813-7110
Practice Address - Street 1:4363 OCOEE ST N STE 3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4894
Practice Address - Country:US
Practice Address - Phone:423-464-6272
Practice Address - Fax:423-813-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO9332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty