Healthcare Provider Details

I. General information

NPI: 1932727609
Provider Name (Legal Business Name): TRAVERS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

8879 W FLAMINGO RD STE 101
LAS VEGAS NV
89147-8732
US

IV. Provider business mailing address

9211 MANGOSTONE LN
LAS VEGAS NV
89147-7904
US

V. Phone/Fax

Practice location:
  • Phone: 702-610-1160
  • Fax: 702-566-4575
Mailing address:
  • Phone: 702-610-1160
  • Fax: 702-566-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: STACY TRAVERS
Title or Position: OWNER
Credential: MFT
Phone: 702-610-1160