MEDICARE: TRAVIS SMITH LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2009023490	MO
2	101YM0800X	Mental Health Counselor	LPC3685	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114015039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS SMITH LPC

Provider Business Mailing Address
First Line	:	3037 LEXINGTON AVE
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-2602
Country	:	US
Telephone Number	:	573-382-7220
Fax Number	:	573-240-9737

Provider Business Practice Location Address
First Line	:	3037 LEXINGTON AVE
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-2602
Country	:	US
Telephone Number	:	573-382-7220
Fax Number	:	573-240-9737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	01/16/2026

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Directions to “ TRAVIS SMITH LPC” Practice Location

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