Provider Demographics
NPI:1073374088
Name:TRUBY, WILLIAM E III (MA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:TRUBY
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 QUAIL HILL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9239
Mailing Address - Country:US
Mailing Address - Phone:530-926-2328
Mailing Address - Fax:
Practice Address - Street 1:510 QUAIL HILL DR
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9239
Practice Address - Country:US
Practice Address - Phone:530-926-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT24171101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional