Healthcare Provider Details

I. General information

NPI: 1285744656
Provider Name (Legal Business Name): MR. TRAVIS SCOTT RISER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 MEDICAL RIDGE RD
CLINTON SC
29325-4541
US

IV. Provider business mailing address

1547 PARKWAY SUITE 100
GREENWOOD SC
29646-4081
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-7375
  • Fax:
Mailing address:
  • Phone: 864-229-7120
  • Fax:

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: