Provider Demographics
NPI:1750700845
Name:TRUMBLE, BRITTANI (LCDC)
Entity type:Individual
Prefix:
First Name:BRITTANI
Middle Name:
Last Name:TRUMBLE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:BRITTANI
Other - Middle Name:A
Other - Last Name:KINNEBREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC
Mailing Address - Street 1:60 CHESTER FIELD CIR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0080
Mailing Address - Country:US
Mailing Address - Phone:903-748-0694
Mailing Address - Fax:
Practice Address - Street 1:6500 SUMMERHILL RD STE B
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1721
Practice Address - Country:US
Practice Address - Phone:800-972-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62589101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)