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NPI Code Detail

MEDICARE: TRAVIS WADE BYRNE LPC

MEDICARE:   TRAVIS WADE BYRNE  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
1101YP2500XProfessional Counselor0015347CO

General Provider Information

NPI Number : 1700391141
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS WADE BYRNE LPC
Provider Business Mailing Address
First Line : 1110 WISDOM HTS
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-2718
Country : US
Telephone Number : 720-459-2833
Fax Number :
Provider Business Practice Location Address
First Line : 1110 WISDOM HTS
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-2718
Country : US
Telephone Number : 720-459-8333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2017
Last Update Date : 03/08/2022

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Directions to “ TRAVIS WADE BYRNE LPC” Practice Location

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