Provider Demographics
NPI:1669674792
Name:ANDERSON, TREVA B (PHD)
Entity type:Individual
Prefix:DR
First Name:TREVA
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 EXECUTIVE PL
Mailing Address - Street 2:SUITE 404
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3807
Mailing Address - Country:US
Mailing Address - Phone:630-232-7245
Mailing Address - Fax:630-232-7246
Practice Address - Street 1:1250 EXECUTIVE PL
Practice Address - Street 2:SUITE 404
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3807
Practice Address - Country:US
Practice Address - Phone:630-232-7245
Practice Address - Fax:630-232-7246
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical