Provider Demographics
NPI:1255707998
Name:TRAYLOR, CYNTHIA ANN (MA, LPC, CART)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANN
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:MA, LPC, CART
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 1758
Mailing Address - Street 2:
Mailing Address - City:NEW WAVERLY
Mailing Address - State:TX
Mailing Address - Zip Code:77358-1758
Mailing Address - Country:US
Mailing Address - Phone:936-662-6424
Mailing Address - Fax:
Practice Address - Street 1:719 SAWDUST RD
Practice Address - Street 2:SUITE 331
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2910
Practice Address - Country:US
Practice Address - Phone:936-662-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional