Healthcare Provider Details

I. General information

NPI: 1811809924
Provider Name (Legal Business Name): TRAVIS R. ANDERSON AAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7224 PACIFIC HWY E
MILTON WA
98354-9654
US

IV. Provider business mailing address

7224 PACIFIC HWY E
MILTON WA
98354-9654
US

V. Phone/Fax

Practice location:
  • Phone: 253-220-6183
  • Fax: 253-458-7842
Mailing address:
  • Phone: 253-220-6183
  • Fax: 253-458-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCAAR.CG.61620140
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: