Travis Childress
Individual provider Active NPI Marriage & Family Therapist · Lambertville, MI
NPI 1326512658 · NPPES record last updated Jan 21, 2019
Key facts
- NPI
- 1326512658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 4101006829 (MI)
- Practice address
- 6530 Secor Rd Ste 10
Lambertville, MI 48144-9456 - Phone
- (734) 854-7061
- NPI assigned
- Jan 21, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4101006829 | MI | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christian Care Connection LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 4101006829 | MI | Yes |
Addresses
Primary practice location
6530 Secor Rd Ste 10
Lambertville, MI 48144-9456
Mailing address
165 Renfrew Ave
Adrian, MI 49221-1807
Phone (417) 588-0977
Other practice location 1
6530 Secor Rd Ste 10
Lambertville, MI 48144-9456
Phone (734) 854-7061
Other providers in Lambertville, MI
- Thomasene Byers
- Lisa Calcamuggio
- Thomas Joseph Calloway
- Eric Alan Carter
- Keith Richard Cherry
- Kelly Nicole Chisholm
- Christian Care Connection LLC
- Citadel Health Equipment Corp.
- Andrew Leon Clark
- Tracy Collum
All providers in Lambertville, MI · Marriage & Family Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.