Provider Demographics
NPI:1801939897
Name:TRAVIS, JOAN THERESE (MSW)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:THERESE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 DEERBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-2609
Mailing Address - Country:US
Mailing Address - Phone:318-640-2827
Mailing Address - Fax:
Practice Address - Street 1:3717 GOVERNMENT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-3358
Practice Address - Country:US
Practice Address - Phone:318-442-4199
Practice Address - Fax:318-487-8798
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4531101YP2500X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist