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General NPI Number Information
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NPI Number | 1821861485
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Entity Type | Organization
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Legal Business Name | TRAVIS JEFFORDS PLLC
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 438 W FRIENDLY AVE
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City | GREENSBORO
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State | NC
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Zip | 27401-2202
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Country | US
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Telephone | 512-635-9971
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 ASHMONT DR
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City | GREENSBORO
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State | NC
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Zip | 27410-3102
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Country | US
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Telephone | 512-635-9971
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TRAVIS JEFFORDS
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Credential | LCMHCA, MDIV
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Telephone | 512-635-9971
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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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