MEDICARE: MS. JEANNE ELLEN TRAVIS

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	106H00000X	Marriage & Family Therapist	45595	CA

General Provider Information

NPI Number	:	1316080021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE ELLEN TRAVIS

Provider Business Mailing Address
First Line	:	150 E OLIVE AVE STE 203
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-1849
Country	:	US
Telephone Number	:	818-973-4899
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 E OLIVE AVE STE 203
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-1849
Country	:	US
Telephone Number	:	818-973-4899
Fax Number	:

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	04/08/2008

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