Provider Demographics
NPI:1588839674
Name:TRUFFO, CASEY L (MFT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:L
Last Name:TRUFFO
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 1:2481 SAN SABA ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8002
Mailing Address - Country:US
Mailing Address - Phone:949-309-2590
Mailing Address - Fax:
Practice Address - Street 1:2212 DUPONT DR STE I
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1551
Practice Address - Country:US
Practice Address - Phone:949-309-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist