Provider Demographics
NPI:1083832059
Name:JEANS, TRAVIS EARL
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:EARL
Last Name:JEANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-4835
Mailing Address - Country:US
Mailing Address - Phone:323-756-9933
Mailing Address - Fax:323-756-9515
Practice Address - Street 1:9001 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4835
Practice Address - Country:US
Practice Address - Phone:323-756-9933
Practice Address - Fax:323-756-9515
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor