Provider Demographics
NPI:1992331631
Name:TRINITY BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:TRINITY BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE USE DISORDER PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:CRINER
Authorized Official - Suffix:
Authorized Official - Credentials:SUDP
Authorized Official - Phone:360-964-4138
Mailing Address - Street 1:138 S 1ST ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3623
Mailing Address - Country:US
Mailing Address - Phone:360-964-4138
Mailing Address - Fax:
Practice Address - Street 1:138 S 1ST ST STE 6
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3623
Practice Address - Country:US
Practice Address - Phone:360-964-4138
Practice Address - Fax:360-964-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA02150615Medicaid