Provider Demographics
NPI:1801102488
Name:TRAVIS, LEAH M (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:M
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:M
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 PROVIDENCE RD STE 100D
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2208
Mailing Address - Country:US
Mailing Address - Phone:919-873-4323
Mailing Address - Fax:919-646-9589
Practice Address - Street 1:150 PROVIDENCE RD STE 100D
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2208
Practice Address - Country:US
Practice Address - Phone:919-873-4323
Practice Address - Fax:919-646-9589
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000023A106H00000X
IL208.000162106H00000X
IL166000905106H00000X
NCLMFT 1592106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist