Individual
TRAVIS A COS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1200 CALLOWHILL ST, PHMC CARE CLINIC, SUITE 101, PHILADELPHIA, PA 19123-3658
(215) 825-8220
(215) 825-8254
Mailing address
1500 MARKET STREET, LM 500 WEST TOWER, PHILADELPHIA, PA 19120-2100
(215) 985-2595
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
018246-1
NY
103TC0700X
Clinical Psychologist
Primary
PS016774
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1312677
—
MA
01
—
685661
TUFTS
MA
01
—
M18708
BLUE CROSS
MA
Enumeration date
09/19/2007
Last updated
07/15/2016
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