Provider Demographics
NPI:1356977045
Name:SEBASTIAN, TREVOR
Entity type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 GLENVIA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2427
Mailing Address - Country:US
Mailing Address - Phone:833-968-7762
Mailing Address - Fax:
Practice Address - Street 1:741 GLENVIA ST STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2427
Practice Address - Country:US
Practice Address - Phone:833-968-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-39268103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst