Provider Demographics
NPI:1992268619
Name:ALT, TRAVIS EARL (LPC)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:EARL
Last Name:ALT
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 1:55 N BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1635
Mailing Address - Country:US
Mailing Address - Phone:304-359-2245
Mailing Address - Fax:304-359-2259
Practice Address - Street 1:55 N BOLTON ST
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1635
Practice Address - Country:US
Practice Address - Phone:304-359-2245
Practice Address - Fax:304-359-2259
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional