Provider Demographics
NPI:1649576026
Name:TRIMBLE, CHARLES RICHARD JR (MS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:TRIMBLE
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 W DESERT INN RD
Mailing Address - Street 2:APT 2079
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-7939
Mailing Address - Country:US
Mailing Address - Phone:678-361-1979
Mailing Address - Fax:
Practice Address - Street 1:5715 W ALEXANDER RD
Practice Address - Street 2:SUITE 155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2800
Practice Address - Country:US
Practice Address - Phone:702-586-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health