Provider Demographics
NPI:1891328316
Name:TRAVIS, REUBEN (LCMHCA)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:REUBEN
Other - Middle Name:
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHCA
Mailing Address - Street 1:1316 PATTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2652
Mailing Address - Country:US
Mailing Address - Phone:828-424-0298
Mailing Address - Fax:
Practice Address - Street 1:1316 PATTON AVE STE D
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2652
Practice Address - Country:US
Practice Address - Phone:828-424-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional