Provider Demographics
NPI:1134470438
Name:DUREPO, TRAVIS C (LCPC CONDITIONAL)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:C
Last Name:DUREPO
Suffix:
Gender:M
Credentials:LCPC CONDITIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-4461
Mailing Address - Country:US
Mailing Address - Phone:207-492-0903
Mailing Address - Fax:855-553-6925
Practice Address - Street 1:658 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-4461
Practice Address - Country:US
Practice Address - Phone:207-492-9003
Practice Address - Fax:855-553-6925
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4038101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECC5725OtherSTATE OF MAINE