Provider Demographics
NPI:1285981704
Name:HEADD, TRAVIS LAMONT (BS)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:LAMONT
Last Name:HEADD
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 E 77TH CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3650
Mailing Address - Country:US
Mailing Address - Phone:405-637-6099
Mailing Address - Fax:
Practice Address - Street 1:7912 E 77TH CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3650
Practice Address - Country:US
Practice Address - Phone:405-637-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health