Provider Demographics
NPI:1487307120
Name:TRAVIS, JOHN PATRICK (M ED, MHC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:M ED, MHC
Other - Prefix:
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Mailing Address - Street 1:1R NEWBURY ST STE 401
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3816
Mailing Address - Country:US
Mailing Address - Phone:617-804-2773
Mailing Address - Fax:617-804-2773
Practice Address - Street 1:1R NEWBURY ST STE 401
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3816
Practice Address - Country:US
Practice Address - Phone:617-804-2773
Practice Address - Fax:617-804-2773
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health