Provider Demographics
NPI:1639704646
Name:ROBINSON, TREVOR BRIAN
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:BRIAN
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 CREEKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8018
Mailing Address - Country:US
Mailing Address - Phone:415-798-7716
Mailing Address - Fax:
Practice Address - Street 1:420 E COTATI AVE
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-4442
Practice Address - Country:US
Practice Address - Phone:707-795-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health