Healthcare Provider Details

I. General information

NPI: 1932832433
Provider Name (Legal Business Name): MARIAH TREVINO LPC, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 E VAN BUREN ST
JOLIET IL
60432-4218
US

IV. Provider business mailing address

134 E VAN BUREN ST
JOLIET IL
60432-4218
US

V. Phone/Fax

Practice location:
  • Phone: 815-239-0395
  • Fax:
Mailing address:
  • Phone: 815-773-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.023189
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: