Doctor Name: | TARA TRUSTY |
NPI Number: | 1013373000 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 368 S Mayo Trl Pikeville, KY - 415011522 |
Business Phone Number: | 6064370047 |
Business Fax Number: | 6064370547 |
Mailing Address: | 368 S Mayo Trl, PIKEVILLE |
State: | KY |
Postal Code: | 415011522 |
Phone Number: | 6064370047 |
Fax Number: | 6064370547 |
NPI Enumeration Date: | 01/07/2016 |
NPI Last Update Date: | 01/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |