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Individual

TRAVIS WIGGETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MA, LCPC

Contact information

Practice address
14 MAINE ST STE 216D, BRUNSWICK, ME 04011-2082
(207) 406-2697
Mailing address
14 MAINE ST STE 216D, BRUNSWICK, ME 04011-2082
(207) 406-2697

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC3364
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
31234-7
BLUE CROSS
RI
01
413206
BLUE CHIP
RI
05
FM49368
RI
Enumeration date
01/05/2007
Last updated
07/25/2019
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