Provider Demographics
NPI:1790157121
Name:ALFORD, TREVIS
Entity Type:Individual
Prefix:
First Name:TREVIS
Middle Name:
Last Name:ALFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 E LOYOLA DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2548
Mailing Address - Country:US
Mailing Address - Phone:504-303-0221
Mailing Address - Fax:
Practice Address - Street 1:3845 E LOYOLA DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2548
Practice Address - Country:US
Practice Address - Phone:504-303-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YS0200X, 3747P1801X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide