Healthcare Provider Details

I. General information

NPI: 1396863270
Provider Name (Legal Business Name): PATRICE TREVOLEDES MA,MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 HARRIS ST
EUREKA CA
95503-4448
US

IV. Provider business mailing address

618 HARRIS ST
EUREKA CA
95503-4448
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-8951
  • Fax: 707-445-4666
Mailing address:
  • Phone: 707-443-8951
  • Fax: 707-445-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number40706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: