MEDICARE: TRAVCO BEHAVIORAL HEALTH, INC.

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	1041C0700X	Clinical Social Worker	0029246	OH
2	106H00000X	Marriage & Family Therapist	2183	OH
3	251B00000X	Case Management Agency	593	OH
4	101YM0800X	Mental Health Counselor	2183	OH

General Provider Information

NPI Number	:	1124086616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVCO BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	8261 MARKET ST STE A
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6254
Country	:	US
Telephone Number	:	330-286-0050
Fax Number	:	330-286-0055

Provider Business Practice Location Address
First Line	:	8261 MARKET ST STE A
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6254
Country	:	US
Telephone Number	:	330-286-0050
Fax Number	:	330-286-0055

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVE KAPP
Credential	:
Telephone Number	:	330-286-0050

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	04/02/2024

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