Provider Demographics
NPI:1093749368
Name:BOBB, TRAVIS SCOTT (PHD, LCMHC)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:SCOTT
Last Name:BOBB
Suffix:
Gender:
Credentials:PHD, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16507 NORTHCROSS DR STE F
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5082
Mailing Address - Country:US
Mailing Address - Phone:704-277-8197
Mailing Address - Fax:980-999-4058
Practice Address - Street 1:16507 NORTHCROSS DRIVE
Practice Address - Street 2:SUITE F
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-277-8197
Practice Address - Fax:980-999-4058
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS4912101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102953Medicaid