Provider Demographics
NPI:1336897313
Name:TRAVELSTEAD, BILLIE MARIE
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:MARIE
Last Name:TRAVELSTEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3548
Mailing Address - Country:US
Mailing Address - Phone:818-448-1287
Mailing Address - Fax:
Practice Address - Street 1:1400 HIGH ST STE B2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4192
Practice Address - Country:US
Practice Address - Phone:541-600-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA125211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical