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General NPI Number Information
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NPI Number | 1689794828
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Entity Type | Individual
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Provider Name | TRAVIS WILKERSON LPC
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 70 BATESVILLE BLVD STE C
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City | BATESVILLE
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State | AR
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Zip | 72501-8972
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Country | US
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Telephone | 870-793-3199
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Fax |
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Provider Business Mailing Address
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Address Line | 1707 LINWOOD DR STE B
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City | PARAGOULD
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State | AR
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Zip | 72450-5365
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Country | US
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Telephone | 870-604-4455
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P0606035
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License Number State | AR
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