Provider Demographics
NPI:1003124801
Name:BLUFORD ITA, TRINA K (LPC)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:K
Last Name:BLUFORD ITA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 N FM 620 APT 1815
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4224
Mailing Address - Country:US
Mailing Address - Phone:512-293-7985
Mailing Address - Fax:888-708-9413
Practice Address - Street 1:910 E CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4206
Practice Address - Country:US
Practice Address - Phone:888-823-9194
Practice Address - Fax:888-708-9413
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65441101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional