Provider Demographics
NPI:1700159431
Name:TRUSS, MARVINA (LCPC)
Entity Type:Individual
Prefix:
First Name:MARVINA
Middle Name:
Last Name:TRUSS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RURAL CLINICS PAHRUMP
Mailing Address - Street 2:240 S.HUMAHUASCA
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048
Mailing Address - Country:US
Mailing Address - Phone:775-751-7406
Mailing Address - Fax:775-751-7409
Practice Address - Street 1:RURAL CLINICS PAHRUMP
Practice Address - Street 2:240 S.HUMAHUASCA
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048
Practice Address - Country:US
Practice Address - Phone:775-751-7406
Practice Address - Fax:775-751-7409
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0004226958101YM0800X
NVCP1260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0004226958OtherSTATE