Provider Demographics
NPI:1982240875
Name:TRI-STAR BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:TRI-STAR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:CAUDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MAC/CC
Authorized Official - Phone:509-780-3081
Mailing Address - Street 1:302 5TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1801
Mailing Address - Country:US
Mailing Address - Phone:509-780-3081
Mailing Address - Fax:
Practice Address - Street 1:302 5TH ST STE 2
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-1801
Practice Address - Country:US
Practice Address - Phone:509-780-3081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1972943090Medicaid