Provider Demographics
NPI:1407818859
Name:TRUSSELL, DAN A (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:A
Last Name:TRUSSELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:DAN
Other - Middle Name:A
Other - Last Name:TRUSSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-1108
Mailing Address - Country:US
Mailing Address - Phone:956-289-7000
Mailing Address - Fax:956-289-7257
Practice Address - Street 1:1901 S 24TH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6533
Practice Address - Country:US
Practice Address - Phone:956-289-7000
Practice Address - Fax:956-289-7257
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2000-03849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138708611Medicaid
TX028198201Medicaid