Provider Demographics
NPI:1033467006
Name:MORRISON, TRAVIS M (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:M
Last Name:MORRISON
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E 2ND ST
Mailing Address - Street 2:STE 401
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4109
Mailing Address - Country:US
Mailing Address - Phone:270-315-1226
Mailing Address - Fax:270-315-1226
Practice Address - Street 1:121 E 2ND ST
Practice Address - Street 2:STE 401
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4109
Practice Address - Country:US
Practice Address - Phone:270-315-1226
Practice Address - Fax:270-240-1224
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166043101YM0800X
KY2523961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100412480Medicaid
KY7100412480Medicaid