Healthcare Provider Details

I. General information

NPI: 1003204496
Provider Name (Legal Business Name): TRAVIS KOBLER M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 GAP ROAD
KNOXVILLE TN
37912
US

IV. Provider business mailing address

301 S PERIMETER PARK DR SUITE 210
NASHVILLE TN
37211-4143
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-0391
  • Fax: 865-525-0393
Mailing address:
  • Phone:
  • 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: