Healthcare Provider Details

I. General information

NPI: 1114277225
Provider Name (Legal Business Name): TRAVIS S HOLMES MHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 BROWNTOWN RD
BISHOPVILLE SC
29010-9664
US

IV. Provider business mailing address

215 N MAGNOLIA ST
SUMTER SC
29150-4943
US

V. Phone/Fax

Practice location:
  • Phone: 803-428-6052
  • Fax: 803-428-5407
Mailing address:
  • Phone: 803-775-9364
  • Fax: 803-773-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: