Travis Medrano Walker, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-7299 Issued in ID

Practice address

720 Chute Canyon Way
Bonners Ferry, ID 83805-5220

Phone

(208) 610-2980

NPI assigned

Aug 21, 2019

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 11, 2024 through Apr 11, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Cultivation, LLC

  • Community/Behavioral Health Agency
  • Coeur D'Alene, ID
  • NPI 1124466990
  NPD (past)

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

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1699322917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 CHUTE CANYON WAY",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838055220",
            "telephone_number": "208-610-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 CHUTE CANYON WAY",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838055220",
            "telephone_number": "208-610-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "TRAVIS",
        "middle_name": "MEDRANO",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-21",
        "last_updated": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LPC-7299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Silas T Thompson, LCSW
• Jessica Tingley
• Uhs of Kootenau River Inc
• Uhs of Kootenau River Inc
• Adetta D Umphenour, LMSW
• Madicyn Weddington
• Kathryn L Wenzel, LCSW
• Robert B. Wenzel, LCPC
• Wild Life Community Counseling PLLC
• Wildwood L.L.C

• Professional Counselor in Bonners Ferry, ID
• Providers in Bonners Ferry, ID by specialty
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.