Provider Demographics
NPI:1275250979
Name:TRAHAN, ROXANNA ROSE
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:ROSE
Last Name:TRAHAN
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 1:1875 MILLVILLE OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-8932
Mailing Address - Country:US
Mailing Address - Phone:336-987-4991
Mailing Address - Fax:
Practice Address - Street 1:1875 MILLVILLE OXFORD RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-8932
Practice Address - Country:US
Practice Address - Phone:336-987-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2207840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist