Provider Demographics
NPI:1649543638
Name:TRAIL, TAMMARA O'NEIL (CAC, CCGC)
Entity type:Individual
Prefix:MS
First Name:TAMMARA
Middle Name:O'NEIL
Last Name:TRAIL
Suffix:
Gender:F
Credentials:CAC, CCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W ADMIRAL DOYLE DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-6408
Mailing Address - Country:US
Mailing Address - Phone:337-373-0002
Mailing Address - Fax:337-373-0125
Practice Address - Street 1:611 WEST ADMIRAL DOYLE DRIVE
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560
Practice Address - Country:US
Practice Address - Phone:337-373-0002
Practice Address - Fax:337-373-0125
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACAC 985101YA0400X
LACCGC 1049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional