Healthcare Provider Details

I. General information

NPI: 1881362572
Provider Name (Legal Business Name): RENAISSANCE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 SOUTHWOOD DR
LAKE CHARLES LA
70605-4131
US

IV. Provider business mailing address

1924 SOUTHWOOD DR
LAKE CHARLES LA
70605-4131
US

V. Phone/Fax

Practice location:
  • Phone: 337-324-1865
  • Fax:
Mailing address:
  • Phone: 337-240-8162
  • Fax: 337-240-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JIMMY F TRAHAN
Title or Position: OWNER
Credential: LPC
Phone: 337-240-8162