Healthcare Provider Details

I. General information

NPI: 1609647569
Provider Name (Legal Business Name): TRAVIS JAMES KARCZEWSKI LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MULL AVE
AKRON OH
44313-7502
US

IV. Provider business mailing address

8625 HARRIS RD
LODI OH
44254-9784
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-5603
  • Fax:
Mailing address:
  • Phone: 330-819-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2405725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: