Provider Demographics
NPI:1124604814
Name:THOMPSON, TRAVIS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 CASON TRL
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-7627
Mailing Address - Country:US
Mailing Address - Phone:615-631-6623
Mailing Address - Fax:
Practice Address - Street 1:1257 CASON TRL
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-7627
Practice Address - Country:US
Practice Address - Phone:615-631-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health