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General NPI Number Information
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NPI Number | 1487186656
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Entity Type | Individual
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Provider Name | TRAVIS THORNTON LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 2280 E 25TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7542
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Country | US
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Telephone | 208-227-2377
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Fax |
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Provider Business Mailing Address
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Address Line | 155 CRIMSON DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3714
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Country | US
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Telephone | 208-589-3628
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-42551
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SWB-2026-0071
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License Number State | NM
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