Provider Demographics
NPI:1013486133
Name:TREVINO, JOHANNA ISELA
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ISELA
Last Name: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 1:106 E VILLARREAL ST
Mailing Address - Street 2:
Mailing Address - City:FALFURRIAS
Mailing Address - State:TX
Mailing Address - Zip Code:78355-5041
Mailing Address - Country:US
Mailing Address - Phone:362-563-3524
Mailing Address - Fax:
Practice Address - Street 1:4301 WESTBANK DR STE A250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4479
Practice Address - Country:US
Practice Address - Phone:877-504-8504
Practice Address - Fax:855-420-6402
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75119101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional