Active NPI
Kenneth Trevino, PH.D.
- Clinical Psychologist
- Dallas, TX
National Provider Identifier
1598188591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 36654
- Practice address
- 12801 N. Central Expressway
Suite 1730
Dallas, TX 75243-1872 - Phone
- (817) 320-0704
- Fax
- (972) 677-7784
- NPI assigned
- Jan 27, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 36654 | TX | Primary |
Addresses
Primary practice location
12801 N. Central Expressway
Suite 1730
Dallas, TX 75243-1872
Mailing address
12801 N. Central Expy
Suite 1730
Dallas, TX 75243-1872
Phone (817) 320-0704
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36654 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447804800000",
"number": "1598188591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12801 N. CENTRAL EXPY",
"address_2": "SUITE 1730",
"city": "DALLAS",
"state": "TX",
"postal_code": "752431872",
"telephone_number": "817-320-0704",
"fax_number": "972-677-7784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12801 N. CENTRAL EXPRESSWAY",
"address_2": "SUITE 1730",
"city": "DALLAS",
"state": "TX",
"postal_code": "752431872",
"telephone_number": "817-320-0704",
"fax_number": "972-677-7784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TREVINO",
"first_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-27",
"last_updated": "2015-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "36654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.