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Provider Information for 1699322917


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TRAVIS MEDRANO WALKER LPC


Sex: Male

NPI: 1699322917
Last Updated: 2023-12-06
Certification Date:

Details

NameValue
NPI1699322917
Enumeration Date2019-08-21
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 720 CHUTE CANYON WAY
BONNERS FERRY, ID 83805-5220
United States

Phone: 208-610-2980 | Fax:
 
Primary Practice Address 720 CHUTE CANYON WAY
BONNERS FERRY, ID 83805-5220
United States

Phone: 208-610-2980 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalIDLPC-7299