Provider Demographics
NPI:1336635374
Name:TREVINO, MELANIE PRIETO (LPC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:PRIETO
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 393
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-0393
Mailing Address - Country:US
Mailing Address - Phone:210-392-5601
Mailing Address - Fax:
Practice Address - Street 1:1005 B ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-1900
Practice Address - Country:US
Practice Address - Phone:830-216-4326
Practice Address - Fax:830-216-4881
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75541101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health