=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689355802
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRAVIS WEBSTER THD, LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2023
-----------------------------------------------------
Last Update Date | 07/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4740 NOB HILL DR
-----------------------------------------------------
City | MURRYSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15668-2121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-873-1606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4740 NOB HILL DR
-----------------------------------------------------
City | MURRYSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15668-2121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-873-1606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 001855
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------