Provider Demographics
NPI:1154642957
Name:CHRISTENSEN, TRAVIS CLYDE (LPC)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:CLYDE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 N HWY 89
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84404-1201
Mailing Address - Country:US
Mailing Address - Phone:801-782-6600
Mailing Address - Fax:801-782-6551
Practice Address - Street 1:3149 N HWY 89
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-1201
Practice Address - Country:US
Practice Address - Phone:801-782-6600
Practice Address - Fax:801-782-6551
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6322605-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional