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General NPI Number Information
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NPI Number | 1043794555
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Entity Type | Individual
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Provider Name | CODIE ALLEN TRENT CMS
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Gender | Male
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 411 COURT ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3932
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Country | US
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Telephone | 740-354-6685
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Fax | 740-876-4005
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Provider Business Mailing Address
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Address Line | 475 GEORGE HOLLOW RD
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City | WAVERLY
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State | OH
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Zip | 45690-9060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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