Provider Demographics
NPI:1518202522
Name:PALACIO, TRENNELL ODESIA (MA, LPCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:TRENNELL
Middle Name:ODESIA
Last Name:PALACIO
Suffix:
Gender:F
Credentials:MA, LPCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 S SEPULVEDA BLVD # 110-243
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3631
Mailing Address - Country:US
Mailing Address - Phone:877-643-6410
Mailing Address - Fax:
Practice Address - Street 1:8939 S SEPULVEDA BLVD # 110-243
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3631
Practice Address - Country:US
Practice Address - Phone:877-643-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-02
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90651101YP2500X
CA101YS0200X101YS0200X
CA12467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool