Provider Demographics
NPI:1215298542
Name:TRENT, CANDI DAWN (MED, LPC CANDIDATE)
Entity type:Individual
Prefix:MRS
First Name:CANDI
Middle Name:DAWN
Last Name:TRENT
Suffix:
Gender:F
Credentials:MED, LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 E LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7337
Mailing Address - Country:US
Mailing Address - Phone:580-286-2600
Mailing Address - Fax:580-286-1087
Practice Address - Street 1:1303 LYNN LN
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-6845
Practice Address - Country:US
Practice Address - Phone:580-286-7025
Practice Address - Fax:580-286-7436
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3090200000XMedicaid
OK3090200000XMedicare Oscar/Certification
OK3090200000XMedicare UPIN
OK3090200000XMedicare PIN