Ethan Michael Trevis

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Practice address

10927 Downey Ave
Downey, CA 90241-3739

Phone

(562) 869-9770

NPI assigned

Sep 26, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindful Healing Mental Health, LLC

  • Adult Mental Health Clinic/Center
  • Downey, CA
  • NPI 1689266843
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1205119286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10927 DOWNEY AVE STE C",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902413739",
            "telephone_number": "562-450-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10927 DOWNEY AVE",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902413739",
            "telephone_number": "562-869-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREVIS",
        "first_name": "ETHAN",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-26",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley Huy Tran, MD
• Jordan Lavell Travis
• Jade Trejo
• Jeanette Trejo, PA
• Robert Trevino
• Jennifer Trif, M.D.
• Richard Trifoglio
• Luisa Trigueros
• Anh Trinh, O.D.
• True Bella Medical Aesthetics

• Adolescent and Children Mental Health Clinic/Center in Downey, CA
• Providers in Downey, CA by specialty
• Adolescent and Children Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.