Provider Demographics
NPI:1285915181
Name:LANE TRAYLOR, BARBARA SUE (MA)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:SUE
Last Name:LANE TRAYLOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:SUE
Other - Last Name:TRAYLOR-LANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:4232 N SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-8517
Mailing Address - Country:US
Mailing Address - Phone:405-231-3150
Mailing Address - Fax:405-231-3157
Practice Address - Street 1:4232 N SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-8517
Practice Address - Country:US
Practice Address - Phone:405-231-3150
Practice Address - Fax:405-231-3157
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)