| Travis Riser, Llc | |
|
634 Wilson Pl Frederick MD 21702-4168 | |
| (301) 399-0198 | |
| Not Available |
| Full Name | Travis Riser, Llc |
|---|---|
| Speciality | Counselor |
| Location | 634 Wilson Pl, Frederick, Maryland |
| Authorized Official Name and Position | Travis Riser (OWNER) |
| Authorized Official Contact | 3013990198 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Travis Riser, Llc 7820b Wormans Mill Dr Pmb #135 Frederick MD 21701 Ph: (301) 399-0198 | Travis Riser, Llc 634 Wilson Pl Frederick MD 21702-4168 Ph: (301) 399-0198 |
| NPI Number | 1790343523 |
|---|---|
| Provider Enumeration Date | 06/05/2019 |
| Last Update Date | 04/20/2022 |
| Certification Date | 04/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790343523 | NPI | - | NPPES |
| 1912475435 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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