Provider Demographics
NPI:1992339816
Name:TRAVIS SCOTT BURCH
Entity type:Organization
Organization Name:TRAVIS SCOTT BURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-500-8655
Mailing Address - Street 1:PO BOX 4752
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0197
Mailing Address - Country:US
Mailing Address - Phone:541-500-8655
Mailing Address - Fax:800-433-1396
Practice Address - Street 1:1040 CRATER LAKE AVE STE D
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6295
Practice Address - Country:US
Practice Address - Phone:541-500-8655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-29
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty