Individual
MR. TRAVIS WAITS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LMFT, LPC
Contact information
Practice address
18650 SW BOONES FERRY RD, SUITE 3, TUALATIN, OR 97062-8491
(503) 680-4734
(503) 536-6839
Mailing address
18650 SW BOONES FERRY RD, SUITE 3, TUALATIN, OR 97062-8491
(503) 680-4734
(503) 536-6839
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
C2157
OR
106H00000X
Marriage & Family Therapist
Primary
T0623
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101YM0800X
COUNSELOR MENTAL HEALTH
OR
Enumeration date
07/14/2006
Last updated
04/14/2011
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