Provider Demographics
NPI:1952659369
Name:TRAVIS, ROBYN LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:LYNN
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 1:4575 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4645
Mailing Address - Country:US
Mailing Address - Phone:971-304-7245
Mailing Address - Fax:971-600-3567
Practice Address - Street 1:4575 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4645
Practice Address - Country:US
Practice Address - Phone:971-304-7245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health