Provider Demographics
NPI:1063638716
Name:TRAVIS, FIONA (PHD)
Entity Type:Individual
Prefix:DR
First Name:FIONA
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 REED RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3074
Mailing Address - Country:US
Mailing Address - Phone:614-457-0024
Mailing Address - Fax:614-457-0026
Practice Address - Street 1:4700 REED RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3074
Practice Address - Country:US
Practice Address - Phone:614-457-0024
Practice Address - Fax:614-457-0026
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2902103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTRCP05041Medicare ID - Type Unspecified