Active NPI
Travis Nichols, PH.D.
- Clinical Psychologist
- Phoenix, AZ
National Provider Identifier
1114431905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS018367
- Practice address
- 9250 W Thomas Rd
Phoenix, AZ 85037-3382 - Phone
- (623) 772-4051
- NPI assigned
- Dec 1, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS018367 | PA | Primary |
Addresses
Primary practice location
9250 W Thomas Rd
Phoenix, AZ 85037-3382
Mailing address
12527 W Modesto Dr
Litchfield Park, AZ 85340-5555
Phone (610) 283-9750
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS018367 | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512086400000",
"number": "1114431905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12527 W MODESTO DR",
"city": "LITCHFIELD PARK",
"state": "AZ",
"postal_code": "853405555",
"telephone_number": "610-283-9750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9250 W THOMAS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850373382",
"telephone_number": "623-772-4051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "TRAVIS",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-01",
"last_updated": "2017-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS018367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.