Provider Demographics
NPI:1740553742
Name:TREVINO, TAMARA MADIE (MARRIAGE & FAMILY TH)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MADIE
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MARRIAGE & FAMILY TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 S DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9476
Mailing Address - Country:US
Mailing Address - Phone:559-738-0700
Mailing Address - Fax:559-738-0710
Practice Address - Street 1:4034 S DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9476
Practice Address - Country:US
Practice Address - Phone:559-738-0700
Practice Address - Fax:559-738-0710
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA132054OtherAMFT