Provider Demographics
NPI:1942417191
Name:WILLADSON, TRUDY (LMFT)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:WILLADSON
Suffix:
Gender:F
Credentials:LMFT
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 348
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-0348
Mailing Address - Country:US
Mailing Address - Phone:408-656-8138
Mailing Address - Fax:
Practice Address - Street 1:309 1/2 S LAFAYETTE ST STE 202
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1967
Practice Address - Country:US
Practice Address - Phone:408-656-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43034106H00000X
MI4101007112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist