Doctor Name: | MR. TRAVIS JAY TROTT |
NPI Number: | 1003162983 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 149017843 |
Business Practice Address: | 715 Lake St Ste 310 Oak Park, IL - 603011422 |
Business Phone Number: | 7733540163 |
Business Fax Number: | |
Mailing Address: | 1414 N Dearborn St, CHICAGO |
State: | IL |
Postal Code: | 606101506 |
Phone Number: | 7733540163 |
Fax Number: | |
NPI Enumeration Date: | 07/30/2012 |
NPI Last Update Date: | 10/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149017843 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |