Provider Demographics
NPI:1144690231
Name:MUNNERLYN, TRAVIS WOOD (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:WOOD
Last Name:MUNNERLYN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ALICE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6304
Mailing Address - Country:US
Mailing Address - Phone:773-677-0937
Mailing Address - Fax:
Practice Address - Street 1:7396 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4206
Practice Address - Country:US
Practice Address - Phone:773-677-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist