Provider Demographics
NPI:1477041747
Name:CHESTER, TRAVIS STERLING
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:STERLING
Last Name:CHESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3508
Mailing Address - Country:US
Mailing Address - Phone:707-564-6238
Mailing Address - Fax:415-520-6530
Practice Address - Street 1:640 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1270
Practice Address - Country:US
Practice Address - Phone:707-564-6238
Practice Address - Fax:415-520-6530
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-35915106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician