Provider Demographics
NPI:1568488724
Name:WAITS, TRAVIS (MA, LMFT, LPC)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:WAITS
Suffix:
Gender:M
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18650 SW BOONES FERRY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8491
Mailing Address - Country:US
Mailing Address - Phone:503-680-4734
Mailing Address - Fax:503-536-6839
Practice Address - Street 1:18650 SW BOONES FERRY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8491
Practice Address - Country:US
Practice Address - Phone:503-680-4734
Practice Address - Fax:503-536-6839
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0623106H00000X
ORC2157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101YM0800XOtherCOUNSELOR MENTAL HEALTH