Organization
ASSISTED AWARENESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD D TRAVIS PSY. D., LCP (LICENSE CLINICAL PSYCHOLOGIST)
(815) 436-1101
Entity
Organization
Contact information
Practice address
24123 W LOCKPORT ST, UNIT 101, PLAINFIELD, IL 60544-2863
(815) 436-1101
(815) 436-1121
Mailing address
24123 W LOCKPORT ST, UNIT 101, PLAINFIELD, IL 60544-2863
(815) 436-1101
(815) 436-1121
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
071008003
IL
Other
Enumeration date
11/12/2010
Last updated
11/12/2010
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