Healthcare Provider Details

I. General information

NPI: 1548329394
Provider Name (Legal Business Name): DALE C. TRAVEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 W 4TH ST
MANSFIELD OH
44903-1672
US

IV. Provider business mailing address

PO BOX 1573
MANSFIELD OH
44901-1573
US

V. Phone/Fax

Practice location:
  • Phone: 419-526-4603
  • Fax: 419-526-4603
Mailing address:
  • Phone: 419-526-4603
  • Fax: 419-526-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.0006139
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.0006139
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0006139
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: