Basic Information
| Provider Information | |||||||||
| NPI: | 1902290489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAMBURO-TREVINO | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | MA, LPC-S, LCDC, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6800 PARK TEN BLVD STE 200S | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782134293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102611000 | ||||||||
| FaxNumber: | 2102611821 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 N FRIO ST # 2 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782073011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102613001 | ||||||||
| FaxNumber: | 2107319661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2015 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 7615 | TX | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 13516 | TX | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 41652 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | 13516 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.