Provider Demographics
NPI:1144689977
Name:HAGE, TRAVIS R (LMHC)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:R
Last Name:HAGE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21705 67TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-7089
Mailing Address - Country:US
Mailing Address - Phone:941-549-1521
Mailing Address - Fax:
Practice Address - Street 1:8636 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3785
Practice Address - Country:US
Practice Address - Phone:941-549-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health