Provider Demographics
NPI:1104203595
Name:SOMERS, TRAVIS (LPC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:SOMERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7274 STONE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 METRO PL N
Practice Address - Street 2:SUITE 150
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5342
Practice Address - Country:US
Practice Address - Phone:740-339-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health