Provider Demographics
NPI:1922634385
Name:GARCIA-TREVINO, ELSA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:GARCIA-TREVINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9448 W QUEEN PALM
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-0939
Mailing Address - Country:US
Mailing Address - Phone:956-455-4684
Mailing Address - Fax:
Practice Address - Street 1:1 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-4933
Practice Address - Country:US
Practice Address - Phone:956-882-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health