Provider Demographics
NPI:1326149279
Name:AGAR, TREVOR MACDONOUGH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:MACDONOUGH
Last Name:AGAR
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 1:1601 W MACARTHUR BLVD APT 27D
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-8229
Mailing Address - Country:US
Mailing Address - Phone:949-400-7287
Mailing Address - Fax:
Practice Address - Street 1:1601 W MACARTHUR BLVD APT 27D
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-8229
Practice Address - Country:US
Practice Address - Phone:949-400-7287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical