Provider Demographics
NPI:1932933819
Name:TRUONG, MICHAEL (LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 LOVELL AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4650
Mailing Address - Country:US
Mailing Address - Phone:510-590-8636
Mailing Address - Fax:
Practice Address - Street 1:522 LOVELL AVE APT 7
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4650
Practice Address - Country:US
Practice Address - Phone:510-590-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4519106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist