Larry R Travis, LCMHT/LSW/CCSS-II

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0084 Issued in MS

Practice address

3550 Highway, 468 West
Fiscal Services
Whitfield, MS 39193-0157

Phone

(601) 351-8000

NPI assigned

Apr 17, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390953600000",
    "number": "1902249238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1",
            "address_2": "3550 HIGHWAY, 468 WEST FISCAL SERVICES",
            "city": "WHITFIELD",
            "state": "MS",
            "postal_code": "391930157",
            "telephone_number": "601-351-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 HIGHWAY, 468 WEST",
            "address_2": "FISCAL SERVICES",
            "city": "WHITFIELD",
            "state": "MS",
            "postal_code": "391930157",
            "telephone_number": "601-351-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVIS",
        "first_name": "LARRY",
        "middle_name": "R",
        "credential": "LCMHT/LSW/CCSS-II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-17",
        "last_updated": "2014-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "0084",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MS",
            "license": "W0709",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "MS",
            "license": "0367",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy D. Shumaker, M.D.
• Ashlie Stepro
• Lisa B Stone, M. D.
• William P. Stone, D.M.D.
• Carolyn Frances Tingle, M. D.
• Clint Trest, PMHNP
• Chassity Nicole Vanderford, NP
• Katrina L. Vaughn, LPN
• Heather Amber Villarreal, MD
• Andrea M. Walls, CCSS

• All providers in Whitfield, MS
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.