Healthcare Provider Details

I. General information

NPI: 1114568573
Provider Name (Legal Business Name): TREVOR TOWNE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 HARTNELL AVE
REDDING CA
96002-1845
US

IV. Provider business mailing address

1189A SANCHEZ ST
SAN FRANCISCO CA
94114-3836
US

V. Phone/Fax

Practice location:
  • Phone: 530-226-7028
  • Fax: 530-226-7689
Mailing address:
  • Phone: 415-577-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS22940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: