Healthcare Provider Details

I. General information

NPI: 1982337408
Provider Name (Legal Business Name): TRAVIS HARRIS MSW, LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 7TH ST W
SAINT PAUL MN
55102-3828
US

IV. Provider business mailing address

1905 3RD ST N
SARTELL MN
56377-2448
US

V. Phone/Fax

Practice location:
  • Phone: 651-758-9500
  • Fax:
Mailing address:
  • Phone: 708-890-7129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28136
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: