Healthcare Provider Details

I. General information

NPI: 1942819313
Provider Name (Legal Business Name): TRAVIS SHUBECK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2991 SHATTUCK AVE STE 303
BERKELEY CA
94705-1872
US

IV. Provider business mailing address

487 BOULEVARD WAY
PIEDMONT CA
94610-1526
US

V. Phone/Fax

Practice location:
  • Phone: 831-331-9391
  • Fax:
Mailing address:
  • Phone: 831-331-9391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: