Individual
LESLIE TRAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1525 CUBA RD, MAYFIELD, KY 42066-6809
(270) 247-2588
Mailing address
425 BROADWAY ST, PADUCAH, KY 42001-0713
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1088190
KY
Other
Enumeration date
01/18/2016
Last updated
01/18/2016
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