Provider Demographics
NPI:1528829538
Name:TRINITY MASTON COUNSELING
Entity type:Organization
Organization Name:TRINITY MASTON COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER. LCPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINITY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MASTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-517-2705
Mailing Address - Street 1:5016 N UNIVERSITY ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4763
Mailing Address - Country:US
Mailing Address - Phone:309-517-2705
Mailing Address - Fax:
Practice Address - Street 1:5016 N UNIVERSITY ST STE 104
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4763
Practice Address - Country:US
Practice Address - Phone:309-517-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health