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General NPI Number Information
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NPI Number | 1790343523
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Entity Type | Organization
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Legal Business Name | TRAVIS RISER, LLC
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 634 WILSON PL
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City | FREDERICK
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State | MD
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Zip | 21702-4168
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Country | US
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Telephone | 301-399-0198
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Fax |
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Provider Business Mailing Address
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Address Line | 7820B WORMANS MILL DR PMB #135
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City | FREDERICK
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State | MD
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Zip | 21701
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Country | US
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Telephone | 301-399-0198
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TRAVIS RISER
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Credential | LCPC
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Telephone | 301-399-0198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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