Provider Demographics
NPI:1902017619
Name:PRICHARD, TRAVIS HOLDEN
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:HOLDEN
Last Name:PRICHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 2ND AVE SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2482
Mailing Address - Country:US
Mailing Address - Phone:541-967-3866
Mailing Address - Fax:541-812-8807
Practice Address - Street 1:425 2ND AVE SW
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2482
Practice Address - Country:US
Practice Address - Phone:541-967-3866
Practice Address - Fax:541-812-8807
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator