=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992447403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUST PROFESSIONALS LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2022
-----------------------------------------------------
Last Update Date | 08/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 MORNINGVIEW LN
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30228-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 167-834-3121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 MORNINGVIEW LN
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30228-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-343-1219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. THOMAS E BROWN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 678-343-1219
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------