Travis Sanderson
Individual provider Active NPI Professional Counselor · Kamas, UT
NPI 1093076200 · NPPES record last updated Mar 9, 2018
Key facts
- NPI
- 1093076200
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 9106771-6004 (UT)
- Practice address
- 228 W 200 S Ste 2E
Kamas, UT 84036-9010 - Phone
- (801) 360-6955
- NPI assigned
- Jun 4, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9106771-6004 | UT | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LS Counseling | Past | Accepting new patients | |
| Expansive Horizons Counseling & Psychological Services, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 9106771-6004 | UT | Yes |
Addresses
Primary practice location
228 W 200 S Ste 2E
Kamas, UT 84036-9010
Mailing address
596 Ash CT
Kamas, UT 84036-9275
Other providers in Kamas, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.