Provider Demographics
NPI:1629597877
Name:BLACK, TRENYE (LMHC)
Entity Type:Individual
Prefix:
First Name:TRENYE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6271 SAINT AUGUSTINE RD STE 24-1426
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2523
Mailing Address - Country:US
Mailing Address - Phone:904-894-4477
Mailing Address - Fax:
Practice Address - Street 1:6271 SAINT AUGUSTINE RD STE 24-1426
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2523
Practice Address - Country:US
Practice Address - Phone:661-320-4015
Practice Address - Fax:661-475-5170
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8300101YP2500X
FLMH15363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional