Provider Demographics
NPI:1962166827
Name:GOPAL, TRISHANA
Entity type:Individual
Prefix:
First Name:TRISHANA
Middle Name:
Last Name:GOPAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W BAY DR STE 109
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3269
Mailing Address - Country:US
Mailing Address - Phone:727-358-8113
Mailing Address - Fax:
Practice Address - Street 1:801 W BAY DR STE 109
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3269
Practice Address - Country:US
Practice Address - Phone:727-358-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)