Provider Demographics
NPI:1417282625
Name:TRUNNELL, SUSAN L (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:TRUNNELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 WINDMILL WAY STE 11
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1379
Mailing Address - Country:US
Mailing Address - Phone:916-485-2497
Mailing Address - Fax:916-485-9751
Practice Address - Street 1:5740 WINDMILL WAY STE 11
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1379
Practice Address - Country:US
Practice Address - Phone:916-485-2497
Practice Address - Fax:916-485-9751
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT34721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist