Provider Demographics
NPI:1619088572
Name:MEAD, TRAVIS MICHAEL (MFT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:MEAD
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 COLIMA RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1814
Mailing Address - Country:US
Mailing Address - Phone:562-945-5454
Mailing Address - Fax:562-693-1184
Practice Address - Street 1:9200 COLIMA RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1814
Practice Address - Country:US
Practice Address - Phone:562-945-5454
Practice Address - Fax:562-693-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC15460OtherMARRIAGE & FAMILY THERAPY