Provider Demographics
NPI:1295136919
Name:WASSON, TRAVIS (PSYD, LP)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:WASSON
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HERITAGE OAK LN STE 1
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4283
Mailing Address - Country:US
Mailing Address - Phone:269-968-2811
Mailing Address - Fax:269-968-2651
Practice Address - Street 1:7 HERITAGE OAK LN STE 1
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4283
Practice Address - Country:US
Practice Address - Phone:269-968-2811
Practice Address - Fax:269-968-2651
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical