Provider Demographics
NPI:1487001046
Name:LESLIE TRUMBLE, PSYD, LLC
Entity Type:Organization
Organization Name:LESLIE TRUMBLE, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:406-498-7120
Mailing Address - Street 1:125 W GRANITE ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9215
Mailing Address - Country:US
Mailing Address - Phone:406-498-7120
Mailing Address - Fax:
Practice Address - Street 1:125 W GRANITE ST
Practice Address - Street 2:SUITE 212
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9215
Practice Address - Country:US
Practice Address - Phone:406-498-7120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1943103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty