Provider Demographics
NPI:1881478030
Name:SUELL, TRAVIS O'NEAL
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:O'NEAL
Last Name:SUELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RIDGE ROW DR APT 208
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3990
Mailing Address - Country:US
Mailing Address - Phone:470-774-4265
Mailing Address - Fax:
Practice Address - Street 1:51 RIDGE ROW DR APT 208
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3990
Practice Address - Country:US
Practice Address - Phone:470-774-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst