Provider Demographics
NPI:1902868946
Name:TRIMBOLI, FRANK (PHD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:TRIMBOLI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 SPRING VALLEY RD
Mailing Address - Street 2:1100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3631
Mailing Address - Country:US
Mailing Address - Phone:972-404-8325
Mailing Address - Fax:
Practice Address - Street 1:4201 SPRING VALLEY RD
Practice Address - Street 2:STE. 1100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3631
Practice Address - Country:US
Practice Address - Phone:972-404-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21003103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036012502Medicaid
TX8D6490Medicare ID - Type Unspecified
TX036012502Medicaid