Provider Demographics
NPI:1902272198
Name:TREVENEN, ROBERT (LCSW,LSUDC, UTAH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:TREVENEN
Suffix:
Gender:M
Credentials:LCSW,LSUDC, UTAH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E 1800 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2611
Mailing Address - Country:US
Mailing Address - Phone:801-874-5794
Mailing Address - Fax:
Practice Address - Street 1:494 W 1400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7001
Practice Address - Country:US
Practice Address - Phone:801-473-3963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4920528-6006101YA0400X
WYLCSW-9271041C0700X
UT4920528-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)