Provider Demographics
NPI:1750438966
Name:STRANGE, TRAVIS RAY (LPC - SUPERVISOR)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:RAY
Last Name:STRANGE
Suffix:
Gender:M
Credentials:LPC - SUPERVISOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1513
Mailing Address - Country:US
Mailing Address - Phone:469-383-9988
Mailing Address - Fax:
Practice Address - Street 1:133 CHIEFTAIN DR STE 105
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1587
Practice Address - Country:US
Practice Address - Phone:469-773-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19661101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176331001Medicaid