Provider Demographics
NPI:1427201094
Name:TRUITT, TIKANA
Entity Type:Individual
Prefix:
First Name:TIKANA
Middle Name:
Last Name:TRUITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CORPORATE PKWY STE 318
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1200
Mailing Address - Country:US
Mailing Address - Phone:716-783-8292
Mailing Address - Fax:
Practice Address - Street 1:100 CORPORATE PKWY STE 318
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1200
Practice Address - Country:US
Practice Address - Phone:716-783-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004439-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health