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NPI Code Detail

MEDICARE: MS. FAITH CLAIR TREVINO MSW, LICSWA

MEDICARE: MS. FAITH CLAIR TREVINO MSW, LICSWA
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
1104100000XSocial WorkerSC70035871WA
21041C0700XClinical Social WorkerSC70035871WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477222156
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. FAITH CLAIR TREVINO MSW, LICSWA
Provider Business Mailing Address
First Line : PO BOX 2394
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8455
Country : US
Telephone Number : 360-200-5419
Fax Number :
Provider Business Practice Location Address
First Line : 1400 COMMERCE AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-3756
Country : US
Telephone Number : 360-998-3050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2021
Last Update Date : 03/17/2026

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