Provider Demographics
NPI:1609597012
Name:TRUSCHEL, SUSAN HOLLAND (RADT R1479390822)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HOLLAND
Last Name:TRUSCHEL
Suffix:
Gender:F
Credentials:RADT R1479390822
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 W. WHITESBRIGE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706
Mailing Address - Country:US
Mailing Address - Phone:559-264-5096
Mailing Address - Fax:
Practice Address - Street 1:2445 W. WHITESBRIGE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706
Practice Address - Country:US
Practice Address - Phone:559-264-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1479390822101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR1479390822OtherCCAPP REGISTRATION