Provider Demographics
NPI:1790091593
Name:TRUSSVILLE FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:TRUSSVILLE FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-276-2419
Mailing Address - Street 1:128 N CHALKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:205-655-3851
Practice Address - Street 1:128 N CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1373
Practice Address - Country:US
Practice Address - Phone:205-276-2419
Practice Address - Fax:205-655-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty