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NPI Code Detail

MEDICARE: MARK TRAVIS

MEDICARE: MARK TRAVIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1558593236
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK TRAVIS
Provider Business Mailing Address
First Line : 8561 FENTON ST
Second Line : STE 230
City : SILVER SPRING
State : MD
Zip : 20910-4455
Country : US
Telephone Number : 301-565-9001
Fax Number : 301-565-9003
Provider Business Practice Location Address
First Line : 8561 FENTON ST
Second Line : STE 230
City : SILVER SPRING
State : MD
Zip : 20910-4455
Country : US
Telephone Number : 301-565-9001
Fax Number : 301-565-9003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2009
Last Update Date : 08/14/2009

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Directions to “ MARK TRAVIS ” Practice Location

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