Provider Demographics
NPI:1144304486
Name:ENTRUST PSYCHOTHERAPY INC.
Entity type:Organization
Organization Name:ENTRUST PSYCHOTHERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:THRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-444-0395
Mailing Address - Street 1:3151 AIRWAY AVE STE K102
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4613
Mailing Address - Country:US
Mailing Address - Phone:714-444-0395
Mailing Address - Fax:714-444-0571
Practice Address - Street 1:3151 AIRWAY AVE STE K102
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4613
Practice Address - Country:US
Practice Address - Phone:714-444-0395
Practice Address - Fax:714-444-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11290103TC0700X
CAMFC39390106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty