MEDICARE: MAYRA TREJO LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	89340	TX
2	101YP2500X	Professional Counselor	89340	TX
3	101YM0800X	Mental Health Counselor	89340	TX

General Provider Information

NPI Number	:	1295566073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA TREJO LPC

Provider Business Mailing Address
First Line	:	213 N FREDONIA ST STE 280
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-7286
Country	:	US
Telephone Number	:	903-472-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 N FREDONIA ST STE 280
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-7286
Country	:	US
Telephone Number	:	903-472-0505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	04/07/2025

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Directions to “ MAYRA TREJO LPC” Practice Location

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