Provider Demographics
NPI:1912475435
Name:RISER, TRAVIS D (LCPC)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:D
Last Name:RISER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820B WORMANS MILL RD
Mailing Address - Street 2:PMB #135
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:301-399-0198
Mailing Address - Fax:
Practice Address - Street 1:634 WILSON PL
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4168
Practice Address - Country:US
Practice Address - Phone:301-399-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7675101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor