Healthcare Provider Details

I. General information

NPI: 1215848858
Provider Name (Legal Business Name): TRAVIS GUY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 E EAST SOLON RD
RICHMOND IL
60071-9675
US

IV. Provider business mailing address

3213 E EAST SOLON RD
RICHMOND IL
60071-9675
US

V. Phone/Fax

Practice location:
  • Phone: 815-679-8243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178033353
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: