Provider Demographics
NPI:1194597880
Name:KERN, TRAVIS J (LPC)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:J
Last Name:KERN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 EL CERRITO DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5911
Mailing Address - Country:US
Mailing Address - Phone:469-231-7598
Mailing Address - Fax:
Practice Address - Street 1:8350 MEADOW RD # 281
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3768
Practice Address - Country:US
Practice Address - Phone:214-265-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78415101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor