Individual
MR. TRAVIS DALE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2255 W NORTHERN AVE, PHOENIX, AZ 85021-4936
(602) 995-1767
(602) 995-1863
Mailing address
2255 W NORTHERN AVE, PHOENIX, AZ 85021-4936
(602) 995-1767
(602) 995-1863
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-18444
AZ
Other
Enumeration date
03/03/2020
Last updated
03/03/2020
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