Provider Demographics
NPI:1962746123
Name:SAWYER, SHEA TRAVIS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:TRAVIS
Last Name:SAWYER
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20550 TOWNSEN BLVD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4445
Mailing Address - Country:US
Mailing Address - Phone:328-792-1078
Mailing Address - Fax:832-442-5044
Practice Address - Street 1:20550 TOWNSEN BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4445
Practice Address - Country:US
Practice Address - Phone:328-792-1078
Practice Address - Fax:832-442-5044
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136900363LP0808X
TX824238163WH0200X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health