Provider Demographics
NPI:1265291868
Name:TRUSSELL, KATHRYN L (LMFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:TRUSSELL
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 1:335 MANONO ST APT D
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2283
Mailing Address - Country:US
Mailing Address - Phone:808-652-7890
Mailing Address - Fax:
Practice Address - Street 1:335 MANONO ST APT D
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2283
Practice Address - Country:US
Practice Address - Phone:808-652-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist