Most Relevant Information
Provider Data
| NPI Number: | 1003037557 |
| Provider Name: | TRAVIS MERRELL TRONE |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/01/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
628 TRACY TER
CENTRALIA
IL
628014478
Practice Location Phone/Fax
| Phone: | 6185332579 |
| Fax: |
Provider Mailing Location
628 TRACY TER
CENTRALIA
IL
628014478
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |