Provider Demographics
NPI:1518116318
Name:TRAVIS, CHERYL KIMPLE (MAED,)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:KIMPLE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:MAED,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E. SPEER BLVD #14
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-8118
Mailing Address - Country:US
Mailing Address - Phone:303-638-9911
Mailing Address - Fax:303-543-0365
Practice Address - Street 1:825 E SPEER BLVD # 14
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3719
Practice Address - Country:US
Practice Address - Phone:303-638-9911
Practice Address - Fax:303-543-0365
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6214101YA0400X
CO10243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)