Provider Demographics
NPI:1578830394
Name:TRAYLOR, ANGELA D
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:D
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-7800
Mailing Address - Country:US
Mailing Address - Phone:479-799-1393
Mailing Address - Fax:
Practice Address - Street 1:250 E CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9240
Practice Address - Country:US
Practice Address - Phone:479-575-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor