ETHAN MICHAEL TREVIS (NPI# 1205119286) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205119286 |
| Entity Type | Individual |
| Full Name | ETHAN MICHAEL TREVIS |
| Practice Address |
10927 Downey Ave Downey CA 90241-3739 |
| Mailing Address |
3451 Orangewood Ave Rossmoor CA 90720-3815 |
| Practice Telephone | 5628699770 |
| Mailing Telephone | 5624805516 |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2020-08-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| Street Address |
10927 DOWNEY AVE |
| City | DOWNEY |
| State | CA |
| Zip Code | 90241-3739 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467625863 | Ike Mendoza | Social Worker | 10927 Downey Ave, Ste C, Downey, CA 90241 | 2008-04-07 |
| 1205088390 | James Angelo Pasino | Clinical Neuropsychologist | 10927 Downey Ave, Suite C, Downey, CA 90241-3739 | 2008-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164029005 | Adam Lyle Barnhardt | Counselor | 11500 Paramont Blvd., Downey, CA 90241 | 2020-10-05 |
| 1922630482 | Betzabeth Benitez Perez | Counselor | Scadp, 11500 Paramount Blvd., Downey, CA 90241 | 2020-02-12 |
| 1457858714 | Diane Padre-gozun | Student in an Organized Health Care Education/Training Program | 11500 Brookshire Ave, Gme Office, Downey, CA 90241 | 2018-04-12 |
| 1295233963 | Community Family Guidance Center | Community/Behavioral Health | 12330 Woodruff Ave, Downey, CA 90241 | 2018-01-29 |
| 1487167433 | Progressive Medical Associates | Health Maintenance Organization | 6611 Seville Avenue, Huntington Park, CA 90241 | 2017-11-13 |
| 1194236018 | Dental Office of Downey Inc. | Clinic/Center | 10917 Paramounth Blvd, Downey, CA 90241 | 2017-10-18 |
| 1376063933 | Sophea Tim | Pharmacist | 11525 Brookshire Avenue Suite 400, Downey, CA 90241 | 2017-06-26 |
| 1952835282 | Dr. Jose Flores D.d.s Inc. | Preferred Provider Organization | 11510 Downey Ave, Downey, CA 90241 | 2017-04-13 |
| 1053844043 | Stephen Nealon Berberich | Internal Medicine | 1544 Downey Ave, Downey, CA 90241 | 2017-04-06 |
| 1225424187 | Davis Huang | Internal Medicine | 11500 Brookshire Ave., Downey, CA 90241 | 2015-04-07 |
| Find all providers in zip 90241 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073112157 | 10-20 Club Inc. | Clinic/Center | 8221 3rd St Ste 403, Downey, CA 90241-3733 | 2020-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447857040 | Mary Cox, Lmft | Clinic/Center | 13800 Heacock St Ste 230a, Moreno Valley, CA 92553-8824 | 2020-10-06 |
| 1821607771 | Tonya Octave, Lcsw, Prof Corp | Clinic/Center | 237 S Lakeview Ave Ste A, Placentia, CA 92870-6756 | 2020-07-27 |
| 1972121762 | Environmental Alternatives Susanville | Clinic/Center | 2003 Main St, Susanville, CA 96130-4501 | 2020-07-08 |
| 1083231781 | Treehouse Child Therapy Professional Corporation | Clinic/Center | 514 N California Ave Ste 13, Beaumont, CA 92223-2120 | 2020-06-29 |
| 1083230262 | Socal Adolescent Wellness, Inc. | Clinic/Center | 23072 Lake Center Dr Ste 214, Lake Forest, CA 92630-2899 | 2020-06-23 |
| 1447876123 | P.h.i.l.o.s.adolescent Treatment Centers, Inc. | Clinic/Center | 454 E Cerritos St, Rialto, CA 92376-3658 | 2020-06-18 |
| 1669098505 | Rowi Valencia, Inc. | Clinic/Center | 27413 Tourney Rd Ste 150, Valencia, CA 91355-5604 | 2020-06-16 |
| 1386267870 | Bni Treatment Centers | Clinic/Center | 2563 Stokes Canyon Rd, Calabasas, CA 91302-2991 | 2020-05-19 |
| 1538781042 | P.h.i.l.o.s.adolescent Treatment Centers, Inc. | Clinic/Center | 3872 Carthage St, Riverside, CA 92501-2102 | 2020-05-07 |
| 1477173813 | Environmental Alternatives | Clinic/Center | 525 W Kettleman Ln, Lodi, CA 95240-6005 | 2020-04-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.