Provider Demographics
NPI:1295807915
Name:SONCRANT, TRUDY MARIE (MSW,LISAC,LCSW)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:MARIE
Last Name:SONCRANT
Suffix:
Gender:F
Credentials:MSW,LISAC,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 WEST CAMPO BELLO DR
Mailing Address - Street 2:SUITE B160
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8529
Mailing Address - Country:US
Mailing Address - Phone:623-533-5138
Mailing Address - Fax:623-533-4271
Practice Address - Street 1:7155 WEST CAMPO BELLO DRIVE
Practice Address - Street 2:SUITE B160
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8529
Practice Address - Country:US
Practice Address - Phone:623-533-5138
Practice Address - Fax:623-533-4271
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4055101Y00000X
AZ1356101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104510Medicare ID - Type UnspecifiedPROVIDER NUMBER