Healthcare Provider Details

I. General information

NPI: 1679328009
Provider Name (Legal Business Name): TRAVIS GALLOWAY SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 WASHINGTON ST
CEDAR FALLS IA
50613-2812
US

IV. Provider business mailing address

945 W PARKER ST
WATERLOO IA
50703-2104
US

V. Phone/Fax

Practice location:
  • Phone: 319-533-6919
  • Fax:
Mailing address:
  • Phone: 319-504-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number095182
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: