MEDICARE: TRAVIS GALLOWAY SR.

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	095182	IA

General Provider Information

NPI Number	:	1679328009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS GALLOWAY SR.

Provider Business Mailing Address
First Line	:	945 W PARKER ST
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50703-2104
Country	:	US
Telephone Number	:	319-504-7325
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 WASHINGTON ST
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-2812
Country	:	US
Telephone Number	:	319-533-6919
Fax Number	:

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

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	04/19/2024

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Directions to “ TRAVIS GALLOWAY SR. ” Practice Location

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