Provider Demographics
NPI:1023396934
Name:TREVON CLOW COUNSELING THERAPIES, INC
Entity Type:Organization
Organization Name:TREVON CLOW COUNSELING THERAPIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEPEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-428-4564
Mailing Address - Street 1:221 N CAUSEWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5298
Mailing Address - Country:US
Mailing Address - Phone:386-428-4564
Mailing Address - Fax:386-428-4539
Practice Address - Street 1:221 N CAUSEWAY
Practice Address - Street 2:SUITE B
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5298
Practice Address - Country:US
Practice Address - Phone:386-428-4564
Practice Address - Fax:386-428-4539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty