Healthcare Provider Details

I. General information

NPI: 1578326195
Provider Name (Legal Business Name): TRAVIS NELSON MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 N SAINT PAUL ST
DENVER CO
80205-4829
US

IV. Provider business mailing address

2665 N SAINT PAUL ST
DENVER CO
80205-4829
US

V. Phone/Fax

Practice location:
  • Phone: 603-321-3536
  • Fax:
Mailing address:
  • Phone: 603-321-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: