MEDICARE: TRUSTFALL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1558223024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUSTFALL THERAPY LLC

Provider Business Mailing Address
First Line	:	10408 MELINDA DR
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-9407
Country	:	US
Telephone Number	:	810-348-7379
Fax Number	:

Provider Business Practice Location Address
First Line	:	10408 MELINDA DR
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-9407
Country	:	US
Telephone Number	:	810-348-7379
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALER
Name	:	FRANK NEWSOME
Credential	:
Telephone Number	:	517-442-3341

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “TRUSTFALL THERAPY LLC ” Practice Location

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