Healthcare Provider Details

I. General information

NPI: 1962123125
Provider Name (Legal Business Name): SEAN BERENSEN TRONVIG CADC-I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64418 BRAE BURN AVE
DESERT HOT SPRINGS CA
92240-1246
US

IV. Provider business mailing address

14230 PALM AVE
DESERT HOT SPRINGS CA
92240
US

V. Phone/Fax

Practice location:
  • Phone: 760-770-2286
  • Fax:
Mailing address:
  • Phone: 760-770-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCICA01530719
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCICA01530719
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: