Provider Demographics
NPI:1326404450
Name:TRUSTY, JARRED DAVID (MA)
Entity Type:Individual
Prefix:MR
First Name:JARRED
Middle Name:DAVID
Last Name:TRUSTY
Suffix:
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 1:5743 CORSA AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6464
Mailing Address - Country:US
Mailing Address - Phone:818-889-4415
Mailing Address - Fax:
Practice Address - Street 1:5743 CORSA AVE STE 207
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6464
Practice Address - Country:US
Practice Address - Phone:818-889-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA73314OtherINTERN NUMBER