Provider Demographics
NPI:1679801880
Name:TREVINO, ANDRES G (LMSW-IPR)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:G
Last Name:TREVINO
Suffix:
Gender:M
Credentials:LMSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6773 STONE OAK
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4347
Mailing Address - Country:US
Mailing Address - Phone:956-621-3373
Mailing Address - Fax:956-621-3373
Practice Address - Street 1:6773 STONE OAK
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4347
Practice Address - Country:US
Practice Address - Phone:956-621-3373
Practice Address - Fax:956-621-3373
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-28
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30112171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator