Provider Demographics
NPI:1154440568
Name:TRAZILE, JEWELL TAMAR (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:JEWELL
Middle Name:TAMAR
Last Name:TRAZILE
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:JEWELL
Other - Middle Name:TAMAR
Other - Last Name:HAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:518 STONEDALE DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-0325
Mailing Address - Country:US
Mailing Address - Phone:252-902-7292
Mailing Address - Fax:
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-239-7924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03046106H00000X
NC1244106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health