Provider Demographics
NPI:1851714604
Name:TRENCH, MYYAHHNNA
Entity Type:Individual
Prefix:MRS
First Name:MYYAHHNNA
Middle Name:
Last Name:TRENCH
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 1:193 BETTY RUBY DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-5308
Mailing Address - Country:US
Mailing Address - Phone:985-713-2417
Mailing Address - Fax:
Practice Address - Street 1:193 BETTY RUBY DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-5308
Practice Address - Country:US
Practice Address - Phone:985-713-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA272708617Medicaid