Provider Demographics
NPI:1770700841
Name:TRAVIS, ALLISON MCKNIGHT (MS, LPC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MCKNIGHT
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9473
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-9473
Mailing Address - Country:US
Mailing Address - Phone:903-918-2459
Mailing Address - Fax:903-295-5858
Practice Address - Street 1:3840 GILMER RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1173
Practice Address - Country:US
Practice Address - Phone:903-918-2459
Practice Address - Fax:903-295-5858
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1671331-02Medicaid