Provider Demographics
NPI:1912672155
Name:TRAVIS WEBB PSYCHOTHERAPY
Entity Type:Organization
Organization Name:TRAVIS WEBB PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-814-4780
Mailing Address - Street 1:5500 W PINNACLE POINTE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8153
Mailing Address - Country:US
Mailing Address - Phone:479-310-0233
Mailing Address - Fax:
Practice Address - Street 1:5500 W PINNACLE POINTE DR STE 204
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8153
Practice Address - Country:US
Practice Address - Phone:479-310-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty