Provider Demographics
NPI:1679331417
Name:LUINSTRA, TREVOR ALLAN (RBT)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:ALLAN
Last Name:LUINSTRA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:MR
Other - First Name:OLLIE
Other - Middle Name:
Other - Last Name:LUINSTRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:419 S POINTE LN
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4325
Mailing Address - Country:US
Mailing Address - Phone:405-312-0151
Mailing Address - Fax:
Practice Address - Street 1:2219 SW 74TH ST STE 109-115
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-3931
Practice Address - Country:US
Practice Address - Phone:405-355-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician