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General NPI Number Information
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NPI Number | 1942417191
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Entity Type | Individual
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Provider Name | TRUDY WILLADSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 309 1/2 S LAFAYETTE ST STE 202
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City | GREENVILLE
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State | MI
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Zip | 48838-1967
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Country | US
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Telephone | 408-656-8138
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 348
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City | SHERIDAN
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State | MI
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Zip | 48884-0348
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Country | US
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Telephone | 408-656-8138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 43034
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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 | 4101007112
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License Number State | MI
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