Provider Demographics
NPI:1265715817
Name:TRAYLOR, JONATHON BRETT (LPC)
Entity type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:BRETT
Last Name:TRAYLOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 RECREATION DR
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-5125
Mailing Address - Country:US
Mailing Address - Phone:870-310-2343
Mailing Address - Fax:
Practice Address - Street 1:1004 RECREATION DR
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-5125
Practice Address - Country:US
Practice Address - Phone:870-310-2343
Practice Address - Fax:888-974-8128
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional