Provider Demographics
NPI:1548412067
Name:TREVINO, ROXANNE A (LICENSE PROFESSIONAL)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:A
Last Name:TREVINO
Suffix:
Gender:F
Credentials:LICENSE PROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 N MCCOLL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4664
Mailing Address - Country:US
Mailing Address - Phone:956-250-2373
Mailing Address - Fax:956-524-5642
Practice Address - Street 1:5415 N MCCOLL RD STE 103
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4664
Practice Address - Country:US
Practice Address - Phone:956-250-2373
Practice Address - Fax:956-524-5642
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62720101YM0800X, 101YM0800X
TX62770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197250701Medicaid