Provider Demographics
NPI:1063847036
Name:TRUSS-COLE, TIFFANY (LMFT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:TRUSS-COLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44709 DATE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3101
Mailing Address - Country:US
Mailing Address - Phone:661-724-6089
Mailing Address - Fax:661-794-7031
Practice Address - Street 1:44709 DATE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-488-8766
Practice Address - Fax:661-794-7031
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75953106H00000X
CA106891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL