Booth, Travis Andrew
Booth, Travis Andrew is an sole proprietor health care provider with primary practice located at 1007 Church St Suite 302, Evanston IL 60201-3624. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Booth, Travis Andrew can be contacted via phone (847) 492-1938.Contact Information
Primary practice address
1007 Church St Suite 302
Evanston IL 60201-3624
Phone: (847) 492-1938
Fax: (847) 423-5670
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 178.008592 | Illinois |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 180.009981 | Illinois |
Profile Details
| NPI number | 1730423393 |
|---|---|
| LBN Legal business name | Booth, Travis Andrew |
| Credentials | MA, LCPC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 20th, 2012 |
| Last updated | Mar 7th, 2016 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730423393 | NPPES |
| Illinois | Other | PHCP058737 | PHILADELPHIA INDEMNITY INSURANCE COMPANY |
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