Provider Demographics
NPI:1376919910
Name:TRUKOSITZ, MARY (LMHC, CDP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TRUKOSITZ
Suffix:
Gender:F
Credentials:LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N TACOMA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3133
Mailing Address - Country:US
Mailing Address - Phone:253-778-0236
Mailing Address - Fax:253-242-5168
Practice Address - Street 1:30 S LOUISIANA ST STE 226
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-9002
Practice Address - Country:US
Practice Address - Phone:253-778-0236
Practice Address - Fax:253-242-5168
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60187413101YA0400X
WALH60249484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)