Provider Demographics
NPI:1700342532
Name:STRESS & TRAUMA TREATMENT CENTER
Entity Type:Organization
Organization Name:STRESS & TRAUMA TREATMENT CENTER
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:MATT
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:270-997-1065
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:270-997-1065
Practice Address - Fax:618-216-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty