| NPI | 1760888796 |
|---|---|
| Former Name | TRAVIS LEE MARTIN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI 15W02622) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136501TELE) |
| 1041C0700X Social Worker, Clinical (Licence: RI CSW01572) | |
| 1041C0700X Social Worker, Clinical (Licence: MA LICSW1140333) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 122255) | |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2025-11-07 |