Provider Demographics
NPI:1083652739
Name:TRENT, MICHON (LSCSW)
Entity Type:Individual
Prefix:
First Name:MICHON
Middle Name:
Last Name:TRENT
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 ROPER ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2918
Mailing Address - Country:US
Mailing Address - Phone:251-432-4264
Mailing Address - Fax:
Practice Address - Street 1:162 ROPER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2918
Practice Address - Country:US
Practice Address - Phone:251-432-4264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS8369OtherPREFERRED HEALTH SYSTEMS
KS070554OtherBLUE CROSS BLUE SHIELD
KSQ28027Medicare UPIN
KS070554Medicare ID - Type Unspecified