Provider Demographics
NPI:1972581759
Name:TRUITT, JACQUALINE COSPER (MA, LPC, LMFT, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUALINE
Middle Name:COSPER
Last Name:TRUITT
Suffix:
Gender:F
Credentials:MA, LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 PASADENA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-3265
Mailing Address - Country:US
Mailing Address - Phone:713-475-0072
Mailing Address - Fax:713-472-8684
Practice Address - Street 1:2601 PASADENA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-3265
Practice Address - Country:US
Practice Address - Phone:713-475-0072
Practice Address - Fax:713-472-8684
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9929101YP2500X
TX1378106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB0035958Medicare UPIN