Provider Demographics
NPI:1023216884
Name:DR YOLANDA A TREVINO LLC
Entity Type:Organization
Organization Name:DR YOLANDA A TREVINO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-932-0146
Mailing Address - Street 1:2580 MONTESSOURI STREET
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3065
Mailing Address - Country:US
Mailing Address - Phone:702-932-0146
Mailing Address - Fax:702-256-2295
Practice Address - Street 1:2580 MONTESSOURI STREET
Practice Address - Street 2:SUITE 101A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3065
Practice Address - Country:US
Practice Address - Phone:702-932-0146
Practice Address - Fax:702-256-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty