Provider Demographics
NPI:1518320035
Name:TREVOR'S PLACE LLC
Entity Type:Organization
Organization Name:TREVOR'S PLACE LLC
Other - Org Name:STABLE LIFE CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:542-833-3440
Mailing Address - Street 1:3000 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5371
Mailing Address - Country:US
Mailing Address - Phone:254-833-3440
Mailing Address - Fax:
Practice Address - Street 1:3000 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5371
Practice Address - Country:US
Practice Address - Phone:254-833-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11211584103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty