Individual
SPARKY JOEL TRAHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
5599 HIGHWAY 311, HOUMA, LA 70360-2866
(985) 857-3615
(985) 876-8824
Mailing address
124A HOLLYWOOD ST, THIBODAUX, LA 70301-4322
(985) 857-3615
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
461634964
PEER SUPPORT SPECIALLIST
LA
Enumeration date
06/27/2019
Last updated
09/10/2020
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