| Trinity Integrative Care, Llc | |
|
12863 County Road 192 Tyler TX 75703-6417 | |
| (903) 805-0229 | |
| Not Available |
| Full Name | Trinity Integrative Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12863 County Road 192, Tyler, Texas |
| Authorized Official Name and Position | Gary Duke (DIRECTOR) |
| Authorized Official Contact | 9035716555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Integrative Care, Llc 6117 Sutherland Dr Tyler TX 75703-4654 Ph: (903) 571-6555 | Trinity Integrative Care, Llc 12863 County Road 192 Tyler TX 75703-6417 Ph: (903) 805-0229 |
| NPI Number | 1043856289 |
|---|---|
| Provider Enumeration Date | 11/22/2019 |
| Last Update Date | 11/22/2019 |
| Medicare PECOS PAC ID | 3476995788 |
|---|---|
| Medicare Enrollment ID | O20240531000646 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043856289 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Gary D Duke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144874207 PECOS PAC ID: 7214361161 Enrollment ID: I20240510001656 |
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