Provider Demographics
NPI:1447065198
Name:SUTTON, TRAVIS (LPC)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:SUTTON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 N HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5653
Mailing Address - Country:US
Mailing Address - Phone:773-560-1829
Mailing Address - Fax:
Practice Address - Street 1:3740 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5653
Practice Address - Country:US
Practice Address - Phone:773-560-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3001026598101YS0200X
IL178021273101YP2500X
AK4127755101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool