Provider Demographics
NPI:1336138551
Name:ADAMS, TRAVIS ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:ROBERT
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 103 BOX 4724
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09603
Mailing Address - Country:US
Mailing Address - Phone:04-349-1279
Mailing Address - Fax:
Practice Address - Street 1:UNIT 6180 BOX 245
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09604
Practice Address - Country:US
Practice Address - Phone:043-466-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY 202808103TC0700X
IDPSY-202080103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent