Healthcare Provider Details

I. General information

NPI: 1972581759
Provider Name (Legal Business Name): JACQUALINE COSPER TRUITT MA, LPC, LMFT, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 PASADENA BLVD
PASADENA TX
77502-3265
US

IV. Provider business mailing address

2601 PASADENA BLVD
PASADENA TX
77502-3265
US

V. Phone/Fax

Practice location:
  • Phone: 713-475-0072
  • Fax: 713-472-8684
Mailing address:
  • Phone: 713-475-0072
  • Fax: 713-472-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9929
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1378
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: