Healthcare Provider Details

I. General information

NPI: 1851771745
Provider Name (Legal Business Name): AMIRA TREVINO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4568 S HIGHLAND DR STE 380
MILLCREEK UT
84117-4213
US

IV. Provider business mailing address

4568 S HIGHLAND DR STE 380
MILLCREEK UT
84117-4213
US

V. Phone/Fax

Practice location:
  • Phone: 385-458-8947
  • Fax:
Mailing address:
  • Phone: 385-867-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60564199
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number14218034-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: