Provider Demographics
NPI:1619795838
Name:TREVINO, LAUREN (LMFTA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 W INTERSTATE 10 STE 775
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1781
Mailing Address - Country:US
Mailing Address - Phone:210-957-1668
Mailing Address - Fax:
Practice Address - Street 1:9901 W INTERSTATE 10 STE 775
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1781
Practice Address - Country:US
Practice Address - Phone:210-957-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205718101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health