Provider Demographics
NPI:1124628169
Name:ATCHISON, TRAVIS BENJAMIN
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:BENJAMIN
Last Name:ATCHISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 68TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-6136
Mailing Address - Country:US
Mailing Address - Phone:277-657-7761
Mailing Address - Fax:727-865-5178
Practice Address - Street 1:3941 68TH AVE N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-6136
Practice Address - Country:US
Practice Address - Phone:277-657-7761
Practice Address - Fax:727-865-5178
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor