Provider Demographics
NPI:1780867143
Name:TRAVIS, HEIDI WINN (LPC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:WINN
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 SW BUCHAREST CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3157
Mailing Address - Country:US
Mailing Address - Phone:503-477-7441
Mailing Address - Fax:503-241-7307
Practice Address - Street 1:1525 NE WEIDLER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1410
Practice Address - Country:US
Practice Address - Phone:503-477-7441
Practice Address - Fax:503-241-7307
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health