Provider Demographics
NPI:1336344019
Name:TRUAX, TINA MARIE (MA, LP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:TRUAX
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 14TH ST NW STE 204
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0229
Mailing Address - Country:US
Mailing Address - Phone:507-203-3464
Mailing Address - Fax:507-322-7660
Practice Address - Street 1:1610 14TH ST NW STE 204
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0229
Practice Address - Country:US
Practice Address - Phone:507-203-3463
Practice Address - Fax:507-322-7660
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5132103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist