Provider Demographics
NPI:1992210876
Name:VERDIN, TRAVIS CHRISTOPHER II (BA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:CHRISTOPHER
Last Name:VERDIN
Suffix:II
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6304
Mailing Address - Country:US
Mailing Address - Phone:985-879-3966
Mailing Address - Fax:985-873-7784
Practice Address - Street 1:420 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-879-3966
Practice Address - Fax:985-873-7784
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health