Provider Demographics
NPI:1639495724
Name:TURLEY, TRAVIS J (LCSW)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:J
Last Name:TURLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 W FAIRVIEW AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-8021
Mailing Address - Country:US
Mailing Address - Phone:208-376-0191
Mailing Address - Fax:208-658-6299
Practice Address - Street 1:10740 W FAIRVIEW AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-8021
Practice Address - Country:US
Practice Address - Phone:208-376-0191
Practice Address - Fax:208-658-6299
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-304381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical