Provider Demographics
NPI:1386203412
Name:TRUSCHEL, JACK H (PSYD/LPC)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:H
Last Name:TRUSCHEL
Suffix:
Gender:M
Credentials:PSYD/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 KETTLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7131
Mailing Address - Country:US
Mailing Address - Phone:570-350-1796
Mailing Address - Fax:570-620-2131
Practice Address - Street 1:79 S COURTLAND ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2865
Practice Address - Country:US
Practice Address - Phone:570-350-1796
Practice Address - Fax:570-620-2131
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health