MEDICARE: TRAVIS ANTONIO SHOULARS MS, MPA, LPCA, NCC

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	13915	NC

General Provider Information

NPI Number	:	1528555398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS ANTONIO SHOULARS MS, MPA, LPCA, NCC

Provider Business Mailing Address
First Line	:	46 CAMDEN CT
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-9077
Country	:	US
Telephone Number	:	252-676-2656
Fax Number	:	252-541-3111

Provider Business Practice Location Address
First Line	:	608 JACKSON ST STE 215
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-2600
Country	:	US
Telephone Number	:	252-676-2656
Fax Number	:	252-541-3111

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

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	03/05/2026

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