Provider Demographics
NPI:1013187368
Name:TRUSTY, MICHAEL (MA, PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TRUSTY
Suffix:
Gender:M
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15501 BRUCE B DOWNS BLVD
Mailing Address - Street 2:#302
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1374
Mailing Address - Country:US
Mailing Address - Phone:813-453-7074
Mailing Address - Fax:813-961-5919
Practice Address - Street 1:3910 NORTHDALE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1800
Practice Address - Country:US
Practice Address - Phone:813-453-7074
Practice Address - Fax:813-961-5919
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health