Provider Demographics
NPI:1780985358
Name:ASSISTED AWARENESS
Entity type:Organization
Organization Name:ASSISTED AWARENESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D, LCP
Authorized Official - Phone:815-436-1101
Mailing Address - Street 1:24123 W LOCKPORT ST
Mailing Address - Street 2:UNIT 101
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2863
Mailing Address - Country:US
Mailing Address - Phone:815-436-1101
Mailing Address - Fax:815-436-1121
Practice Address - Street 1:24123 W LOCKPORT ST
Practice Address - Street 2:UNIT 101
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2863
Practice Address - Country:US
Practice Address - Phone:815-436-1101
Practice Address - Fax:815-436-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008003251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health