Provider Demographics
NPI:1124220264
Name:WARE, DAN TRAVIS (MS)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:TRAVIS
Last Name:WARE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 ROYAL LN APT 301
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-1820
Mailing Address - Country:US
Mailing Address - Phone:214-221-4839
Mailing Address - Fax:
Practice Address - Street 1:9910 ROYAL LN APT 301
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1820
Practice Address - Country:US
Practice Address - Phone:214-221-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX461719Medicaid