| Doctor Name: | KENNETH TRIVISON |
| NPI Number: | 1114969862 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | E0000375 |
| Business Practice Address: | 25111 Country Club Blvd Suite 290 North Olmsted, OH - 440705345 |
| Business Phone Number: | 4406142520 |
| Business Fax Number: | 4406142526 |
| Mailing Address: | 24800 Highpoint Rd, BEACHWOOD |
| State: | OH |
| Postal Code: | 441226041 |
| Phone Number: | 2168316611 |
| Fax Number: | 2168312726 |
| NPI Enumeration Date: | 06/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | E0000375 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |