MEDICARE: TRAVIS JOHN WRANITZ 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	101YP2500X	Professional Counselor	37PC00436400	NJ

General Provider Information

NPI Number	:	1215286695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS JOHN WRANITZ LPC

Provider Business Mailing Address
First Line	:	4 CODINGTON LN
Second Line	:
City	:	GLEN GARDNER
State	:	NJ
Zip	:	08826-3508
Country	:	US
Telephone Number	:	973-487-7407
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 CODINGTON LN
Second Line	:
City	:	GLEN GARDNER
State	:	NJ
Zip	:	08826-3508
Country	:	US
Telephone Number	:	973-487-7407
Fax Number	:

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

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	08/31/2012

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