Provider Demographics
NPI:1225510274
Name:TINSLEY, TRENTON L
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:L
Last Name:TINSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22713 S ELLSWORTH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7886
Mailing Address - Country:US
Mailing Address - Phone:480-445-0943
Mailing Address - Fax:
Practice Address - Street 1:22713 S ELLSWORTH RD STE 101
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7886
Practice Address - Country:US
Practice Address - Phone:480-445-0943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health