Provider Demographics
NPI:1083315766
Name:HUPP, TRAVIS W (LADAC II, CAADC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:W
Last Name:HUPP
Suffix:
Gender:M
Credentials:LADAC II, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 RIVERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-6569
Mailing Address - Country:US
Mailing Address - Phone:615-636-5604
Mailing Address - Fax:
Practice Address - Street 1:8337 SAWYER BROWN RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2539
Practice Address - Country:US
Practice Address - Phone:615-636-5604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001126101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)