Provider Demographics
NPI:1275290876
Name:KAPP, TRAVIS (LLPC)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:KAPP
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E BELLEVUE ST APT A15
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:MI
Mailing Address - Zip Code:49251-9365
Mailing Address - Country:US
Mailing Address - Phone:517-376-8887
Mailing Address - Fax:
Practice Address - Street 1:5030 NORTHWIND DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5034
Practice Address - Country:US
Practice Address - Phone:517-333-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional