Kristian Glynn Travis

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

110 Boston St
Salem, MA 01970-1402

Phone

(978) 744-7905

NPI assigned

Aug 28, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Justice Resource Institute, IncGroup PAC ID 3274430590, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Justice Resource Institute, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Salem, MA
  • NPI 1093787095
  Medicare reassignment Care Compare group NPD
• Justice Resource Institute, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Acton, MA
  • NPI 1295909760
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1295348233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BOSTON ST",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019701402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BOSTON ST",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019701402",
            "telephone_number": "978-744-7905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVIS",
        "first_name": "KRISTIAN",
        "middle_name": "GLYNN",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jadeliz Toribio
• Gary Torres Holguin
• Alejandra Consuelo Torres
• Elissa Riggio Tosi, LICSW
• Jennifer L Traficanti, LICSW
• Wayne Trebbin, MD
• Aiden Scott Tremblay
• Christyne Tremblay
• Robin Ann Trenti, CCC-A
• Briana Leigh Tricomi, LMHC

• Mental Health Counselor in Salem, MA
• Providers in Salem, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.