Provider Demographics
NPI:1275185647
Name:PARTAIN, TRUDIE LYNN
Entity Type:Individual
Prefix:
First Name:TRUDIE
Middle Name:LYNN
Last Name:PARTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 RANKIN DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4336
Mailing Address - Country:US
Mailing Address - Phone:409-651-7554
Mailing Address - Fax:
Practice Address - Street 1:5825 PHELAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6200
Practice Address - Country:US
Practice Address - Phone:409-651-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional