Provider Demographics
NPI:1598494163
Name:TREVINO, CRYSTAL J (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:J
Last Name:TREVINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 SHANNON LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4728
Mailing Address - Country:US
Mailing Address - Phone:512-483-1968
Mailing Address - Fax:
Practice Address - Street 1:1402 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-1451
Practice Address - Country:US
Practice Address - Phone:512-483-1968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health