Provider Demographics
NPI:1679328009
Name:GALLOWAY, TRAVIS SR
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:GALLOWAY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 W PARKER ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-2104
Mailing Address - Country:US
Mailing Address - Phone:319-504-7325
Mailing Address - Fax:
Practice Address - Street 1:409 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2812
Practice Address - Country:US
Practice Address - Phone:319-533-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health