Provider Demographics
NPI:1306118567
Name:DUNCAN, TRAVIS (PSYD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S ARCH ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3515
Mailing Address - Country:US
Mailing Address - Phone:724-626-9941
Mailing Address - Fax:724-626-2785
Practice Address - Street 1:51 W HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1343
Practice Address - Country:US
Practice Address - Phone:724-627-0922
Practice Address - Fax:724-627-0940
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3044897101YM0800X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health