Provider Demographics
NPI:1194438226
Name:TRUJILLO, JESUS H (LPC)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:H
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 N LAKEHARBOR LN STE 248
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-6281
Mailing Address - Country:US
Mailing Address - Phone:208-991-4696
Mailing Address - Fax:208-902-3728
Practice Address - Street 1:3050 N LAKEHARBOR LN STE 248
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6281
Practice Address - Country:US
Practice Address - Phone:208-991-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty