Provider Demographics
NPI:1992420723
Name:MARTIN, TRASHENNA CANTRELL (PSY D)
Entity type:Individual
Prefix:DR
First Name:TRASHENNA
Middle Name:CANTRELL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 BORDELON LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3861
Mailing Address - Country:US
Mailing Address - Phone:281-254-2822
Mailing Address - Fax:
Practice Address - Street 1:2531 BORDELON LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3861
Practice Address - Country:US
Practice Address - Phone:281-254-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATK860045225XM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA8-2373125OtherLEGAL ZOOM