Provider Demographics
NPI:1437287927
Name:TREVINO, YOLANDA A (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:A
Last Name:TREVINO
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 S JONES BLVD
Mailing Address - Street 2:STE. 345
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6729
Mailing Address - Country:US
Mailing Address - Phone:702-437-9654
Mailing Address - Fax:
Practice Address - Street 1:620 E. TWAIN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169
Practice Address - Country:US
Practice Address - Phone:702-437-9654
Practice Address - Fax:702-823-3381
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507921Medicaid