Individual
TRAVIS MARTIN SHIVLEY-SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
10535 HOSPITAL WAY, MATHER, CA 95655-4200
(916) 765-1903
Mailing address
418 PEPPER CT, VACAVILLE, CA 95687-3324
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
32064
CA
103T00000X
Psychologist
32064
CA
103TC0700X
Clinical Psychologist
32064
CA
Other
Enumeration date
06/24/2021
Last updated
10/07/2022
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