Provider Demographics
NPI:1376426577
Name:TRAVIS, ELIZABETH CELESTE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CELESTE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N MCMORAN
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-1123
Mailing Address - Country:US
Mailing Address - Phone:810-712-6696
Mailing Address - Fax:
Practice Address - Street 1:8032 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450-9719
Practice Address - Country:US
Practice Address - Phone:810-201-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician