Individual provider Active NPI

Mary Elise Trahan, LAC

  • Addiction (Substance Use Disorder) Counselor
  • Lafayette, LA
National Provider Identifier
1356900013
Registry record updated Jun 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
501 W Saint Mary Blvd Ste 210
Lafayette, LA 70506-4699
Phone
(337) 233-1114
NPI assigned
Jun 6, 2019
Last updated
Jun 6, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X Primary

Addresses

Primary practice location

501 W Saint Mary Blvd Ste 210
Lafayette, LA 70506-4699

Mailing address

PO Box 53388
Lafayette, LA 70505-3388

Other identifiers 1

IdentifierTypeStateIssuer
1582OtherLASTATE - LICENSED ADDICTION COUNSELOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Addiction Specialists PastSince Nov 16, 2021 Accepting new patients
Lake Professionals LLC Past Accepting new patients
Lake Wellness Center, LLC Past Accepting new patients
Lake Wellness Center, LLC PastSince Nov 10, 2019 Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1356900013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53388",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705053388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W SAINT MARY BLVD STE 210",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705064699",
            "telephone_number": "337-233-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAHAN",
        "first_name": "MARY",
        "middle_name": "ELISE",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-06",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE - LICENSED ADDICTION COUNSELOR",
            "identifier": "1582",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.