Provider Demographics
NPI:1467579029
Name:TRUMBULL, JIM
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:TRUMBULL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5054 PEAR BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1664
Mailing Address - Country:US
Mailing Address - Phone:509-452-5461
Mailing Address - Fax:
Practice Address - Street 1:5054 PEAR BUTTE DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1664
Practice Address - Country:US
Practice Address - Phone:509-452-5461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health