Provider Demographics
NPI:1306468020
Name:TREVEDAN, INC
Entity type:Organization
Organization Name:TREVEDAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-552-4210
Mailing Address - Street 1:34778 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8990
Mailing Address - Country:US
Mailing Address - Phone:562-552-4210
Mailing Address - Fax:310-356-3886
Practice Address - Street 1:34778 HICKORY LN
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-8990
Practice Address - Country:US
Practice Address - Phone:562-552-4210
Practice Address - Fax:310-356-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty