Provider Demographics
NPI:1053038703
Name:TRENHOLM, EVAN MICHAEL
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:MICHAEL
Last Name:TRENHOLM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:TRENHOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1535
Mailing Address - Country:US
Mailing Address - Phone:508-209-7688
Mailing Address - Fax:
Practice Address - Street 1:5 NATALIE WAY
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3557
Practice Address - Country:US
Practice Address - Phone:508-858-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst