Healthcare Provider Details

I. General information

NPI: 1629524228
Provider Name (Legal Business Name): TROSCLAIR SEALS MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 S KINNEOLA AVE
PASAD CA
91706
US

IV. Provider business mailing address

36 S KINNEOLA AVE
PASAD CA
91706
US

V. Phone/Fax

Practice location:
  • Phone: 626-844-3033
  • Fax:
Mailing address:
  • Phone: 626-844-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number78780
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number78780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: