Provider Demographics
NPI:1609698430
Name:TINA TRUAX, LLC
Entity type:Organization
Organization Name:TINA TRUAX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUAX
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:507-203-3464
Mailing Address - Street 1:1130 1/2 7TH ST NW STE 206
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2994
Mailing Address - Country:US
Mailing Address - Phone:507-203-3464
Mailing Address - Fax:
Practice Address - Street 1:1130 1/2 7TH ST NW STE 206
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2994
Practice Address - Country:US
Practice Address - Phone:507-203-3464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty