Active NPI
Travis V Wonders, PSYD
- Psychologist
- Portland, OR
National Provider Identifier
1922395565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2969
- Practice address
- 17645 NW Saint Helens Rd
Portland, OR 97231-1729 - Phone
- (503) 621-1069
- Fax
- (503) 621-0200
- NPI assigned
- Jul 4, 2011
- Last updated
- Sep 28, 2023
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY61384058 | WA | |
| Psychologist | 103T00000X | 2969 | OR | Primary |
Addresses
Primary practice location
17645 NW Saint Helens Rd
Portland, OR 97231-1729
Mailing address
1776 SW Madison St
Portland, OR 97205-1715
Phone (971) 386-2278
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2106557 | Medicaid | WA | |
| 500655832 | Medicaid | OR |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY61384058 | WA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Mental Health | Current | Accepting new patients |
Interoperability endpoints
- traviswonders@tdh.allscriptsdirect.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Lewisville, TX
- NPI 1245403567
Mental Health
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695859200000",
"number": "1922395565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1776 SW MADISON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972051715",
"telephone_number": "971-386-2278",
"fax_number": "503-224-4494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17645 NW SAINT HELENS RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972311729",
"telephone_number": "503-621-1069",
"fax_number": "503-621-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONDERS",
"first_name": "TRAVIS",
"middle_name": "V",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-04",
"last_updated": "2023-09-28",
"certification_date": "2023-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY61384058",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "2969",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2106557",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500655832",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.