Basic Information
| Provider Information | |||||||||
| NPI: | 1821148669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLSINGER | ||||||||
| FirstName: | TRUDY | ||||||||
| MiddleName: | JEWELL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | AS, CCDC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 MOFFETT RD | ||||||||
| Address2: | |||||||||
| City: | LUCAS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448439797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198922688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 270 STERKEL BLVD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449071508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195266168 | ||||||||
| FaxNumber: | 4195262753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 021374 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.