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NPI Code Detail

MEDICARE: MR. ANDREW POWELL TRAVIS LISW, LICDC

MEDICARE: MR. ANDREW POWELL TRAVIS LISW, LICDC
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
11041C0700XClinical Social WorkerI10062OH

General Provider Information

NPI Number : 1164614905
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW POWELL TRAVIS LISW, LICDC
Provider Business Mailing Address
First Line : 1791 ALUM CREEK DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1708
Country : US
Telephone Number : 614-445-8131
Fax Number : 614-324-5456
Provider Business Practice Location Address
First Line : 1791 ALUM CREEK DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1708
Country : US
Telephone Number : 614-445-8131
Fax Number : 614-324-5456
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2007
Last Update Date : 08/15/2007

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