Provider Demographics
NPI:1326540626
Name:TRAYLOR, JANEASE L (MS, LPA)
Entity Type:Individual
Prefix:
First Name:JANEASE
Middle Name:L
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:MS, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2595
Mailing Address - Country:US
Mailing Address - Phone:501-472-6000
Mailing Address - Fax:
Practice Address - Street 1:750 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2595
Practice Address - Country:US
Practice Address - Phone:501-472-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist