Healthcare Provider Details

I. General information

NPI: 1245156470
Provider Name (Legal Business Name): PRISCILLA ROSE TREJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W BULLARD AVE STE 101
CLOVIS CA
93612-0861
US

IV. Provider business mailing address

255 W BULLARD AVE # ATE101
CLOVIS CA
93612-0861
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-2608
  • Fax:
Mailing address:
  • Phone: 559-307-9184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW139176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: