Provider Demographics
NPI:1720810732
Name:TREVISAN COELHO, THAINA
Entity type:Individual
Prefix:
First Name:THAINA
Middle Name:
Last Name:TREVISAN COELHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THAINA
Other - Middle Name:TREVISAN
Other - Last Name:VILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2312 CAPE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1633
Mailing Address - Country:US
Mailing Address - Phone:650-278-5397
Mailing Address - Fax:
Practice Address - Street 1:1799 KIRBY DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5607
Practice Address - Country:US
Practice Address - Phone:650-278-5397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-370973106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician