Provider Demographics
NPI:1548300965
Name:TRUSTY, JOHN C (MS, BCBA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:TRUSTY
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 ANSLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6433
Mailing Address - Country:US
Mailing Address - Phone:470-219-8271
Mailing Address - Fax:877-597-8037
Practice Address - Street 1:3845 ANSLEY PARK DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:470-219-8271
Practice Address - Fax:877-597-8037
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst