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General NPI Number Information
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NPI Number | 1912475435
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Entity Type | Individual
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Provider Name | TRAVIS D. RISER LCPC
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Gender | Male
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Dates
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Enumeration Date | 11/02/2018
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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 RD 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 |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LC7675
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License Number State | MD
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