Travis Vanderbilt, MA, LADC, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3253 Issued in MN

Practice address

680 Stewart Ave
Saint Paul, MN 55102-4117

Phone

(651) 292-2420

Fax

(651) 292-2436

NPI assigned

Jun 8, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1659000255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 STEWART AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551024117",
            "telephone_number": "651-292-2420",
            "fax_number": "651-292-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 STEWART AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551024117",
            "telephone_number": "651-292-2420",
            "fax_number": "651-292-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERBILT",
        "first_name": "TRAVIS",
        "credential": "MA, LADC, LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303534",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "3253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tvanderbilt@hazeldenbettyford.org",
            "affiliation": "N",
            "endpointDescription": "Outlook",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "680 Stewart Ave",
            "city": "Saint Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551024117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael Vancleve, MA LP LADC
• Kay Marie Vandenberg
• Michelle Marie Vander Linden, C.O.T.A.
• Erica Lynn Vanderbilt, PA-C
• Katherine A Vanderbilt, CNM
• Emily M Vanderbrink, RD
• Jane Willse Vanelli
• Keagan Vaneperen-Sattler, MA, ATR-P
• Sally Renee Vanerstrom, L.I.C.S.W.
• Vang Chiropractic

• Mental Health Counselor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.