| NPI | 1780985358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD D TRAVIS License Clinical Psychologist 815-436-1101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 071008003) |
| Enumeration Date | 2010-11-12 |
| Last Update Date | 2010-11-12 |