Healthcare Provider Details

I. General information

NPI: 1083550024
Provider Name (Legal Business Name): TRACEY D TRAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N GRUBB ST
COLUMBUS OH
43215-2748
US

IV. Provider business mailing address

2156 BALFORD SQ E
COLUMBUS OH
43232-3948
US

V. Phone/Fax

Practice location:
  • Phone: 614-827-3373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: