Provider Demographics
NPI:1558798835
Name:TRAVIS, ROBERT CHRISTOPHER (MA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHRISTOPHER
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 S BEACON ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3740
Mailing Address - Country:US
Mailing Address - Phone:424-903-9333
Mailing Address - Fax:
Practice Address - Street 1:4703 MILNE DR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3337
Practice Address - Country:US
Practice Address - Phone:424-903-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114771102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst