Provider Demographics
NPI:1760575088
Name:TRAHAN, DONALD EVERETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EVERETT
Last Name:TRAHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 DELAWARE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3067
Mailing Address - Country:US
Mailing Address - Phone:409-898-8222
Mailing Address - Fax:409-898-4946
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:409-898-8222
Practice Address - Fax:409-898-4946
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23008103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QH02Medicare ID - Type Unspecified
TXR58803Medicare UPIN