Provider Demographics
NPI:1790046423
Name:TREVINO, JOANNA L (LPC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
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 1:7300 BLANCO RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4936
Mailing Address - Country:US
Mailing Address - Phone:210-219-4302
Mailing Address - Fax:855-814-9356
Practice Address - Street 1:7300 BLANCO RD
Practice Address - Street 2:SUITE 501
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4936
Practice Address - Country:US
Practice Address - Phone:210-219-4302
Practice Address - Fax:855-814-9356
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66771101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health