Provider Demographics
NPI:1811535164
Name:CROTSER, TRAVIS JASON (MA, LLPC)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JASON
Last Name:CROTSER
Suffix:
Gender:M
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18123 S FISHER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9148
Mailing Address - Country:US
Mailing Address - Phone:269-567-8459
Mailing Address - Fax:
Practice Address - Street 1:103 S 4TH ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1819
Practice Address - Country:US
Practice Address - Phone:269-651-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health