Healthcare Provider Details

I. General information

NPI: 1124086616
Provider Name (Legal Business Name): TRAVCO BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 MARKET ST STE A
BOARDMAN OH
44512-6254
US

IV. Provider business mailing address

8261 MARKET ST STE A
BOARDMAN OH
44512-6254
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-0050
  • Fax: 330-286-0055
Mailing address:
  • Phone: 330-286-0050
  • Fax: 330-286-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0029246
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2183
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number593
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2183
License Number StateOH

VIII. Authorized Official

Name: MR. DAVE KAPP
Title or Position: OWNER
Credential:
Phone: 330-286-0050