Provider Demographics
NPI:1528452398
Name:STEPHENS, TRAVIS REED (LSW)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:REED
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 S STATE ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-8076
Mailing Address - Country:US
Mailing Address - Phone:801-273-6550
Mailing Address - Fax:
Practice Address - Street 1:1875 S STATE ST STE 1000
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-8076
Practice Address - Country:US
Practice Address - Phone:801-273-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-34510104100000X
UT10448871-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker