Provider Demographics
NPI:1588203111
Name:KENNETH TREVINO, PH.D., PLLC
Entity Type:Organization
Organization Name:KENNETH TREVINO, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-320-0704
Mailing Address - Street 1:12801 N CENTRAL EXPY STE 1730
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1872
Mailing Address - Country:US
Mailing Address - Phone:817-320-0704
Mailing Address - Fax:972-677-7784
Practice Address - Street 1:12801 N CENTRAL EXPY STE 1730
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1872
Practice Address - Country:US
Practice Address - Phone:817-320-0704
Practice Address - Fax:972-677-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty