Provider Demographics
NPI:1851966014
Name:STRESS & TRAUMA TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:STRESS & TRAUMA TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:270-997-1065
Mailing Address - Street 1:1200 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-1723
Mailing Address - Country:US
Mailing Address - Phone:618-252-9036
Mailing Address - Fax:618-216-9993
Practice Address - Street 1:1200 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1723
Practice Address - Country:US
Practice Address - Phone:618-252-9036
Practice Address - Fax:618-216-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health