Provider Demographics
NPI:1568654440
Name:TREXLER, JUDY MARTIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:MARTIN
Last Name:TREXLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6011
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-6011
Mailing Address - Country:US
Mailing Address - Phone:229-671-1461
Mailing Address - Fax:229-671-1471
Practice Address - Street 1:109 W JANE ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-3950
Practice Address - Country:US
Practice Address - Phone:229-671-1461
Practice Address - Fax:229-671-1471
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109170CMedicaid
202I801586Medicare PIN