Provider Demographics
NPI:1336855238
Name:TRAHAN, MERIDETH RENEE (MFT-IT)
Entity Type:Individual
Prefix:
First Name:MERIDETH
Middle Name:RENEE
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:MFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FRAUST CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-3626
Mailing Address - Country:US
Mailing Address - Phone:608-332-6360
Mailing Address - Fax:
Practice Address - Street 1:6601 GRAND TETON PLZ STE B3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1056
Practice Address - Country:US
Practice Address - Phone:608-332-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI833-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist