Provider Demographics
NPI:1689362345
Name:BABB, TRAVIS REESE (BA MS BIP)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:REESE
Last Name:BABB
Suffix:
Gender:M
Credentials:BA MS BIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8804 N SPOKANE ST
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4808
Mailing Address - Country:US
Mailing Address - Phone:208-596-9036
Mailing Address - Fax:
Practice Address - Street 1:8804 N SPOKANE ST
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4808
Practice Address - Country:US
Practice Address - Phone:208-596-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst