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General NPI Number Information
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NPI Number | 1801326525
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Entity Type | Individual
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Provider Name | TRAVIS BRETT HENDERSON EDD, BCBA
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Gender | Male
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 70 GREENLEAF ST
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6197
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Country | US
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Telephone | 904-813-2660
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Fax |
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Provider Business Mailing Address
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Address Line | 70 GREENLEAF ST
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6197
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Country | US
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Telephone | 904-813-2660
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-10-6972
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License Number State |
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