Individual
TRAVIS VANDERBILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LADC, LPCC
Contact information
Practice address
680 STEWART AVE, SAINT PAUL, MN 55102-4117
(651) 292-2420
(651) 292-2436
Mailing address
680 STEWART AVE, SAINT PAUL, MN 55102-4117
(651) 292-2420
(651) 292-2436
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303534
MN
101YM0800X
Mental Health Counselor
Primary
3253
MN
Other
Enumeration date
06/08/2022
Last updated
06/08/2022
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