Provider Demographics
NPI:1801556014
Name:TROSCHINETZ, MARK ADAMS (LCDC, SAP, ADC, CART)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ADAMS
Last Name:TROSCHINETZ
Suffix:
Gender:M
Credentials:LCDC, SAP, ADC, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 W SHANDON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-6338
Mailing Address - Country:US
Mailing Address - Phone:432-557-6921
Mailing Address - Fax:888-804-2543
Practice Address - Street 1:3106 W KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-7124
Practice Address - Country:US
Practice Address - Phone:432-557-6921
Practice Address - Fax:888-804-2543
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11202103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty