Provider Demographics
NPI:1144459835
Name:TRENT, THOMAS ANDREW (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ANDREW
Last Name:TRENT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 W RACE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3845
Mailing Address - Country:US
Mailing Address - Phone:812-369-8504
Mailing Address - Fax:
Practice Address - Street 1:3721 W RACE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3845
Practice Address - Country:US
Practice Address - Phone:812-369-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003958A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical