Provider Demographics
NPI:1992341366
Name:TRAVIS, MICHAEL (MA, LPCC, NCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 WASHINGTON LN APT F1
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5979
Mailing Address - Country:US
Mailing Address - Phone:720-245-9946
Mailing Address - Fax:
Practice Address - Street 1:7200 E DRY CREEK RD STE E207
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2569
Practice Address - Country:US
Practice Address - Phone:303-660-5397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional