Provider Demographics
NPI:1457863540
Name:MYERS, TRAVIS LANE (LCPC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LANE
Last Name:MYERS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7902
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-7902
Mailing Address - Country:US
Mailing Address - Phone:406-461-6902
Mailing Address - Fax:
Practice Address - Street 1:111 N LAST CHANCE GULCH STE 2A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4144
Practice Address - Country:US
Practice Address - Phone:406-461-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-29
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1455101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health