Active NPI
Trevar Shyshka
- Addiction (Substance Use Disorder) Counselor
- San Jose, CA
National Provider Identifier
1609324433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 430080AN
- Practice address
- 810 Palm St
San Jose, CA 95110-3030 - Phone
- (408) 500-6229
- Fax
- (408) 294-5072
- NPI assigned
- Sep 21, 2016
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 430080AN | CA | Primary |
Addresses
Primary practice location
810 Palm St
San Jose, CA 95110-3030
Mailing address
810 Palm St
San Jose, CA 95110-3030
Phone (408) 500-6229
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430080AN | Other | CA | DHCS CALIFORNIA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 430080AN | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Truth Recovery Foundation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Children's Substance Abuse Rehabilitation Facility
- San Jose, CA
- NPI 1942758909
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474416000000",
"number": "1609324433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 PALM ST",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951103030",
"telephone_number": "408-500-6229",
"fax_number": "408-294-5072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 PALM ST",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951103030",
"telephone_number": "408-500-6229",
"fax_number": "408-294-5072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHYSHKA",
"first_name": "TREVAR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-21",
"last_updated": "2016-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "430080AN",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DHCS CALIFORNIA",
"identifier": "430080AN",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.