NPIMap

Individual provider Active NPI

Richard D Travis Jr., PSY.D, LCP

  • Clinical Psychologist
  • Plainfield, IL
National Provider Identifier
1902989122
Registry record updated Jan 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.008003 Issued in IL
Practice address
24123 W Lockport St
Unit 101
Plainfield, IL 60544-2863
Phone
(815) 436-1101
Fax
(815) 436-1121
NPI assigned
Oct 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 180003461 IL
Clinical Psychologist 103TC0700X 071.008003 IL Primary

Addresses

Primary practice location

24123 W Lockport St
Unit 101
Plainfield, IL 60544-2863

Mailing address

24123 W Lockport St
Unit 101
Plainfield, IL 60544-2863
Phone (815) 436-1101

Other identifiers 4

IdentifierTypeStateIssuer
11723317OtherILAETNA
0009932335OtherILBCBS IL
581473OtherILVALUE OPTIONS
802121000OtherILMAGELLAN

Other names 1

  • Dr. Bo Travis Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
180003461ILMDProfessional Counselor
071.008003ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Assisted Awareness Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295222400000",
    "number": "1902989122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24123 W LOCKPORT ST",
            "address_2": "UNIT 101",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605442863",
            "telephone_number": "815-436-1101",
            "fax_number": "815-436-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24123 W LOCKPORT ST",
            "address_2": "UNIT 101",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605442863",
            "telephone_number": "815-436-1101",
            "fax_number": "815-436-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVIS",
        "first_name": "RICHARD",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSY.D, LCP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2011-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180003461",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.008003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "11723317",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IL",
            "identifier": "0009932335",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "581473",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "802121000",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BO",
            "last_name": "TRAVIS",
            "prefix": "DR.",
            "credential": "PSY.D, LCP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.