Provider Demographics
NPI:1558520551
Name:AVILA-TRIVINO, ODALINDA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ODALINDA
Middle Name:
Last Name:AVILA-TRIVINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ODALINDA
Other - Middle Name:
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:6843 STANLEY
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402
Mailing Address - Country:US
Mailing Address - Phone:708-613-7912
Mailing Address - Fax:773-296-3226
Practice Address - Street 1:6843 STANLEY
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-613-7912
Practice Address - Fax:773-296-3226
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178003229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional