Provider Demographics
NPI:1578053260
Name:TRAVIS, TIMIEKA CHERRY'LE
Entity Type:Individual
Prefix:MRS
First Name:TIMIEKA
Middle Name:CHERRY'LE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TIMIEKA
Other - Middle Name:CHERRY'LE
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4824 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-5720
Mailing Address - Country:US
Mailing Address - Phone:253-232-8337
Mailing Address - Fax:
Practice Address - Street 1:521 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4238
Practice Address - Country:US
Practice Address - Phone:253-232-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA.MC.61536615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health