Provider Demographics
NPI:1821390998
Name:PRAXIS, JAYNE X (MSSW)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:X
Last Name:PRAXIS
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:TRAVIS
Other - Middle Name:L
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1941 BISHOP LN STE 1019
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1928
Mailing Address - Country:US
Mailing Address - Phone:502-457-8820
Mailing Address - Fax:
Practice Address - Street 1:1941 BISHOP LN STE 1019
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1928
Practice Address - Country:US
Practice Address - Phone:502-457-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical