Healthcare Provider Details

I. General information

NPI: 1033630512
Provider Name (Legal Business Name): TRAVIS LEE PIERON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

IV. Provider business mailing address

2211 SE 105TH CT
VANCOUVER WA
98664-5331
US

V. Phone/Fax

Practice location:
  • Phone: 360-836-0529
  • Fax:
Mailing address:
  • Phone: 360-953-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC60894403
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61056175
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: