Provider Demographics
NPI:1942774229
Name:DAVIS, TRAVIS L (MS, ALC)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MS, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 STRATFORD CT NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1947
Mailing Address - Country:US
Mailing Address - Phone:256-417-5561
Mailing Address - Fax:
Practice Address - Street 1:800 ARCADIA DR NW
Practice Address - Street 2:STE C
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5910
Practice Address - Country:US
Practice Address - Phone:256-937-2525
Practice Address - Fax:256-937-2555
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-19
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3274A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL233352Medicaid