Provider Demographics
NPI:1689428237
Name:TRAHAN, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
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 1:12430 GRANT RD STE A
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7912
Mailing Address - Country:US
Mailing Address - Phone:281-719-9509
Mailing Address - Fax:
Practice Address - Street 1:12430 GRANT RD STE A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-7912
Practice Address - Country:US
Practice Address - Phone:281-719-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician