Healthcare Provider Details

I. General information

NPI: 1447065198
Provider Name (Legal Business Name): TRAVIS SUTTON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 N CLYBOURN AVE UNIT 101
CHICAGO IL
60618-8369
US

IV. Provider business mailing address

2946 N CLYBOURN AVE UNIT 101
CHICAGO IL
60618-8369
US

V. Phone/Fax

Practice location:
  • Phone: 773-560-1829
  • Fax:
Mailing address:
  • Phone: 773-560-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number3590002754
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number4127656
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026032113
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0011
License Number StateMP
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178021273
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number4127755
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: