Provider Demographics
NPI:1538423454
Name:VILLANUEVA, TRINA LISA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:LISA
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 W SHAW AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3303
Mailing Address - Country:US
Mailing Address - Phone:559-916-7144
Mailing Address - Fax:
Practice Address - Street 1:2416 W SHAW AVE STE 114
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3303
Practice Address - Country:US
Practice Address - Phone:559-374-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA68582106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health