Provider Demographics
NPI:1205051612
Name:PARHAM, MARTHA TRIMBLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:TRIMBLE
Last Name:PARHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BELLE TRACE RD
Mailing Address - Street 2:
Mailing Address - City:LECOMPTE
Mailing Address - State:LA
Mailing Address - Zip Code:71346-9553
Mailing Address - Country:US
Mailing Address - Phone:318-416-1430
Mailing Address - Fax:
Practice Address - Street 1:6410 MASONIC DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-2319
Practice Address - Country:US
Practice Address - Phone:318-442-3163
Practice Address - Fax:318-442-9785
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1816884Medicaid
LA3B441Medicare PIN