Provider Demographics
NPI:1225134380
Name:ELLIOTT, TRENT JEWEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:JEWEL
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1585 3RD ST
Mailing Address - Street 2:6136
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-5102
Mailing Address - Country:US
Mailing Address - Phone:337-531-6682
Mailing Address - Fax:337-531-3760
Practice Address - Street 1:1585 3RD ST
Practice Address - Street 2:6136
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5102
Practice Address - Country:US
Practice Address - Phone:337-531-6682
Practice Address - Fax:337-531-3760
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling