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General NPI Number Information
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NPI Number | 1477211183
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Entity Type | Individual
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Provider Name | ROSEMARIE ENEDELIA TREVINO
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Gender | Female
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 12725 SW MILLIKAN WAY STE 300
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City | BEAVERTON
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State | OR
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Zip | 97005-1687
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Country | US
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Telephone | 503-906-7945
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Fax |
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Provider Business Mailing Address
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Address Line | 767 SHENANDOAH DR SE
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City | SALEM
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State | OR
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Zip | 97317-5759
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Country | US
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Telephone | 541-992-0543
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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