Individual
LARRY R TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCMHT/LSW/CCSS-II
Contact information
Practice address
3550 HIGHWAY, 468 WEST, FISCAL SERVICES, WHITFIELD, MS 39193-0157
(601) 351-8000
Mailing address
P.O. BOX 1, 3550 HIGHWAY, 468 WEST FISCAL SERVICES, WHITFIELD, MS 39193-0157
(601) 351-8000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0084
MS
104100000X
Social Worker
W0709
MS
171M00000X
Case Manager/Care Coordinator
0367
MS
Other
Enumeration date
04/17/2013
Last updated
01/29/2014
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