Provider Demographics
NPI:1598803702
Name:TRUESDELL, PAT ALTON (LCSW)
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:ALTON
Last Name:TRUESDELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1452
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-1452
Mailing Address - Country:US
Mailing Address - Phone:907-260-3745
Mailing Address - Fax:907-260-3746
Practice Address - Street 1:43335 KALIFORNSKY BEACH RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8260
Practice Address - Country:US
Practice Address - Phone:907-260-3745
Practice Address - Fax:907-260-3746
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK728OtherLCSW LICENSE #