MEDICARE: STACY TRAVERS LLC

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

General Provider Information

NPI Number	:	1932727609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACY TRAVERS LLC

Provider Business Mailing Address
First Line	:	9211 MANGOSTONE LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7904
Country	:	US
Telephone Number	:	702-610-1160
Fax Number	:	735-205-2696

Provider Business Practice Location Address
First Line	:	3230 S BUFFALO DR STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2506
Country	:	US
Telephone Number	:	702-610-1160
Fax Number	:	735-205-2696

Authorized Official
Title or Position	:	OWNER
Name	:	STACY TRAVERS
Credential	:	MFT
Telephone Number	:	702-610-1160

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	03/30/2026

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Directions to “STACY TRAVERS LLC ” Practice Location

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