Healthcare Provider Details

I. General information

NPI: 1568367811
Provider Name (Legal Business Name): TREVOR JOHN DREZEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 BREMO RD STE 101
RICHMOND VA
23226-2442
US

IV. Provider business mailing address

1164 S ACOMA ST APT 315C
DENVER CO
80210-1592
US

V. Phone/Fax

Practice location:
  • Phone: 804-214-7663
  • Fax:
Mailing address:
  • Phone: 847-636-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019646
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: