Provider Demographics
NPI:1902604937
Name:HARTNELL, TRINITY
Entity type:Individual
Prefix:
First Name:TRINITY
Middle Name:
Last Name:HARTNELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 S NETTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5970
Mailing Address - Country:US
Mailing Address - Phone:417-874-1906
Mailing Address - Fax:417-771-3723
Practice Address - Street 1:2864 S NETTLETON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5970
Practice Address - Country:US
Practice Address - Phone:417-874-1906
Practice Address - Fax:417-771-3723
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023020354103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst