Provider Demographics
NPI:1902430028
Name:EMERIZY, TRAVIS (LMSW)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:EMERIZY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S AMERICANA BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4976
Mailing Address - Country:US
Mailing Address - Phone:208-706-6375
Mailing Address - Fax:208-706-6395
Practice Address - Street 1:703 S AMERICANA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4976
Practice Address - Country:US
Practice Address - Phone:208-706-6375
Practice Address - Fax:208-706-6395
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID365981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical