1801939897 NPI number — MS. JOAN THERESE TRAVIS M.S.W.

Table of content: MS. JOAN THERESE TRAVIS M.S.W. (NPI 1801939897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801939897 NPI number — MS. JOAN THERESE TRAVIS M.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAVIS
Provider First Name:
JOAN
Provider Middle Name:
THERESE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801939897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 DEERBROOK TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71360-2609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-640-2827
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3717 GOVERNMENT ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71302-3358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-442-4199
Provider Business Practice Location Address Fax Number:
318-487-8798
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  4531 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 4531 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 4531 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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