Provider Demographics
NPI:1093740177
Name:TREVINO, LORENZA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LORENZA
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-0534
Mailing Address - Country:US
Mailing Address - Phone:956-437-6867
Mailing Address - Fax:956-488-9641
Practice Address - Street 1:206 S AVASOLO ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-4523
Practice Address - Country:US
Practice Address - Phone:956-487-0464
Practice Address - Fax:956-488-9641
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178455501Medicaid