Individual
LISA TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
515 E BROADWAY, COUNCIL BLUFFS, IA 51503-4419
(712) 322-1407
Mailing address
515 E BROADWAY, COUNCIL BLUFFS, IA 51503-4419
(712) 322-1407
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
082169
IA
Other
Enumeration date
01/12/2018
Last updated
12/18/2025
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