Travis, Richard D

Travis, Richard D is an sole proprietor health care provider with primary practice located at 24123 W Lockport St Unit 101, Plainfield IL 60544-2863. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Travis, Richard D can be contacted via phone (815) 436-1101.

Contact Information

Primary practice address
24123 W Lockport St Unit 101 Plainfield IL 60544-2863
Phone: (815) 436-1101
Fax: (815) 436-1121
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 180003461 Illinois
Behavioral Health & Social Service Providers / Clinical 103TC0700X 071.008003 Illinois

Profile Details

NPI number 1902989122
LBN Legal business name Travis, Richard D
Credentials PSY.D, LCP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 23rd, 2006
Last updated Jan 17th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902989122 NPPES
Illinois Other 11723317 AETNA
Illinois Other 0009932335 AETNA
Illinois Other 581473 AETNA
Illinois Other 802121000 AETNA

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