Provider Demographics
NPI:1114061637
Name:TRAHAN, JIMMIE D (LPC)
Entity Type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:D
Last Name:TRAHAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 W IH 10
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2246
Mailing Address - Country:US
Mailing Address - Phone:210-833-1909
Mailing Address - Fax:
Practice Address - Street 1:25834 HAZY HOLW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-3500
Practice Address - Country:US
Practice Address - Phone:210-833-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84991LOtherALPHA OMEGA BCBS