Provider Demographics
NPI:1184327827
Name:SEEWALD, TRAVIS (LMSW)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:SEEWALD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 EGRET AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78132-0111
Mailing Address - Country:US
Mailing Address - Phone:512-217-8209
Mailing Address - Fax:
Practice Address - Street 1:2000 E LAMAR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7361
Practice Address - Country:US
Practice Address - Phone:628-229-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109479104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker