Provider Demographics
NPI:1821861485
Name:TRAVIS JEFFORDS PLLC
Entity Type:Organization
Organization Name:TRAVIS JEFFORDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFORDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA, MDIV
Authorized Official - Phone:512-635-9971
Mailing Address - Street 1:5400 ASHMONT DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3102
Mailing Address - Country:US
Mailing Address - Phone:512-635-9971
Mailing Address - Fax:
Practice Address - Street 1:438 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2202
Practice Address - Country:US
Practice Address - Phone:512-635-9971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty