Healthcare Provider Details

I. General information

NPI: 1033382783
Provider Name (Legal Business Name): ASSISTED AWARENESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24123 WEST LOCKPORT ROAD
PLAINFIELD IL
60544-2900
US

IV. Provider business mailing address

24123 W LOCKPORT ROAD
PLAINFIELD IL
60544-2900
US

V. Phone/Fax

Practice location:
  • Phone: 815-436-1101
  • Fax:
Mailing address:
  • Phone: 815-436-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. RICHARD TRAVIS
Title or Position: COUNSELOR
Credential: LCPC
Phone: 815-436-1101