Provider Demographics
NPI:1679878441
Name:TREVIZO, BERNADETTE VANESSA (LPC)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:VANESSA
Last Name:TREVIZO
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 1:6040 SURETY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2043
Mailing Address - Country:US
Mailing Address - Phone:915-781-9900
Mailing Address - Fax:
Practice Address - Street 1:6040 SURETY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2043
Practice Address - Country:US
Practice Address - Phone:915-781-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382651301Medicaid