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Individual
MR. TRAVIS MARK SMITH
Active
Individual
MR. TRAVIS MARK SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLBSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802087942
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M00000X
—
MI
Enumeration date
11/20/2013
Last updated
03/17/2018
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