Active NPI
Travis Maurice Mallory
- Mental Health Counselor
- Lincoln, NE
National Provider Identifier
1720676083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 2641 S 70TH St Ste a
Lincoln, NE 68506-2912 - Phone
- (402) 327-9711
- NPI assigned
- Jan 4, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | CPSS-070 | NE | |
| Mental Health Counselor | 101YM0800X | NE | Primary |
Addresses
Primary practice location
2641 S 70TH St Ste a
Lincoln, NE 68506-2912
Mailing address
5308 S 65TH Street Cir
Lincoln, NE 68516-2382
Phone (402) 480-5306
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CPSS-070 | NE | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627862400000",
"number": "1720676083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5308 S 65TH STREET CIR",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685162382",
"telephone_number": "402-480-5306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2641 S 70TH ST STE A",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685062912",
"telephone_number": "402-327-9711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLORY",
"first_name": "TRAVIS",
"middle_name": "MAURICE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-04",
"last_updated": "2021-08-02",
"certification_date": "2021-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NE",
"license": "CPSS-070",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.