STRESS & TRAUMA TREATMENT CENTER, INC. (NPI# 1700342532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700342532 |
| Entity Type | Organization |
| Organization Name | STRESS & TRAUMA TREATMENT CENTER, INC. |
| Practice Address |
1200 Locust St Eldorado IL 62930-1723 |
| Practice Telephone | 2709971065 |
| Practice Fax Number | 6182169993 |
| Mailing Telephone | 2709971065 |
| Mailing Fax Number | 6182169993 |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2020-04-13 |
| Authorized Official Name | DR. DONALD MATTHEW BUCKMAN (LICENSED PSYCHOLOGIST) |
| Authorized Official Telephone | 2709971065 |
| Authorized Official Credential | PH D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | STRESS & TRAUMA TREATMENT CENTER, INC. | 1200 Locust St, Eldorado, IL 62930-1723 |
| Street Address |
1200 LOCUST ST |
| City | ELDORADO |
| State | IL |
| Zip Code | 62930-1723 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992331813 | Flor Eldridge | Social Worker | 1200 Locust St, Eldorado, IL 62930-1723 | 2020-03-23 |
| 1386293900 | Asha K Unni | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-09-06 |
| 1366097669 | Kelsey Atteberry | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-08-05 |
| 1568017853 | Brooke Frazer | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-08-05 |
| 1932753035 | Mylissa Mary Slane | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164951802 | Jeanette Long X | Licensed Practical Nurse | 70 Alexander St, Eldorado, IL 62930 | 2017-06-07 |
| 1720510514 | Mckayla Addison Wren | Counselor | 1412 Us. 45n, Eldorado, IL 62930 | 2017-03-30 |
| 1407394901 | Melody Jo Smith | Licensed Practical Nurse | 2260 Raleigh Road, Eldorado, IL 62930 | 2017-02-03 |
| 1205250412 | Becks Long Term Care Pharmacy Inc | Pharmacy | 1413 Locust Street, Eldorado, IL 62930 | 2014-02-07 |
| 1346559283 | Danny Ray Phillips | Pharmacist | 1021 Us Hwy 45 North, Eldorado, IL 62930 | 2010-09-27 |
| 1447434477 | Elana Ruth Floyd-kennett | Social Worker | 1007 Route 45, Eldorado, IL 62930 | 2007-12-27 |
| 1417150376 | Luke Tyler Hall | Family Medicine | 1407 Locust St, Eldorado, IL 62930 | 2007-06-07 |
| 1134320039 | Eldorado Community Unit School District #4 | Local Education Agency (LEA) | 1040 Washington, Eldorado, IL 62930 | 2007-05-29 |
| 1013071026 | Marion Eye Centers Ltd. | Durable Medical Equipment & Medical Supplies | 1204 U.S. 45 N., Eldorado, IL 62930 | 2006-12-21 |
| 1467536557 | Debra Dian Rumsey | Licensed Practical Nurse | 607 4th Street, Eldorado Rural Health Clinic, Eldorado, IL 62930 | 2006-10-25 |
| Find all providers in zip 62930 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497982847 | Donald M Buckman | Psychologist | 1910 4th St, Eldorado, IL 62930-1741 | 2009-06-12 |
| 1386293900 | Asha K Unni | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-09-06 |
| 1366097669 | Kelsey Atteberry | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-08-05 |
| 1568017853 | Brooke Frazer | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-08-05 |
| 1932753035 | Mylissa Mary Slane | Psychologist | 1200 Locust St, Eldorado, IL 62930-1723 | 2019-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902441603 | Jasmine Dominique Jones | Psychologist | 19041 Willow Ave, Country Club Hills, IL 60478-5740 | 2019-11-18 |
| 1912483074 | Kristina Kochanova | Psychologist | 3380 Lacrosse Lane, Suites 106-107, Naperville, IL 60564 | 2018-07-12 |
| 1235647470 | Laurie Gayes Thompson | Psychologist | 225 E Chicago Ave # 2, Chicago, IL 60611-2991 | 2018-01-22 |
| 1558874891 | Claire Ashling Coyne | Psychologist | 225 E Chicago Ave # 10b, Chicago, IL 60611-2991 | 2017-11-08 |
| 1659721967 | Micah Ioffe | Psychologist | 1300 W Belmont Ave Ste 501, Chicago, IL 60657 | 2016-06-16 |
| 1609243856 | Humboldt Behavioral Health Group | Psychologist | 3317 W Le Moyne St, Chicago, IL 60651-2452 | 2015-08-24 |
| 1003156928 | Early Autism Project, Inc. | Psychologist | 599 Falling Waters Way, Lindenhurst, IL 60046-1703 | 2013-03-01 |
| 1659610491 | Alexandra M Psihogios | Psychologist | 1110 W Columbia Ave, Apt 1n, Chicago, IL 60626-4522 | 2013-02-13 |
| 1265781934 | Anthony Thomas Vesco | Psychologist | 225 E Chicago Ave # 10a, Chicago, IL 60611-2991 | 2012-09-10 |
| 1891044038 | Irma Porcic Khelghati | Psychologist | 1200 Harger Rd Ste 600, Oak Brook, IL 60523-1820 | 2012-09-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.