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General NPI Number Information
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NPI Number | 1144304486
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Entity Type | Organization
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Legal Business Name | ENTRUST PSYCHOTHERAPY INC.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3151 AIRWAY AVE STE K102
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City | COSTA MESA
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State | CA
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Zip | 92626-4613
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Country | US
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Telephone | 714-444-0395
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Fax | 714-444-0571
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Provider Business Mailing Address
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Address Line | 3151 AIRWAY AVE STE K102
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City | COSTA MESA
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State | CA
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Zip | 92626-4613
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Country | US
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Telephone | 714-444-0395
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Fax | 714-444-0571
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN L THRASHER
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Credential | PHD
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Telephone | 714-444-0395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY11290
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC39390
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License Number State | CA
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