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General NPI Number Information
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NPI Number | 1154642957
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Entity Type | Individual
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Provider Name | TRAVIS CLYDE CHRISTENSEN LPC
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Gender | Male
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 3149 N HWY 89
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City | PLEASANT VIEW
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State | UT
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Zip | 84404-1201
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Country | US
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Telephone | 801-782-6600
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Fax | 801-782-6551
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Provider Business Mailing Address
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Address Line | 3149 N HWY 89
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City | PLEASANT VIEW
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State | UT
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Zip | 84404-1201
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Country | US
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Telephone | 801-782-6600
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Fax | 801-782-6551
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6322605-6004
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License Number State | UT
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