Provider Demographics
NPI:1487985834
Name:TRAYLOR, SHEREEN L (PHD)
Entity type:Individual
Prefix:MS
First Name:SHEREEN
Middle Name:L
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S ENTERPRIZE PKWY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-4118
Mailing Address - Country:US
Mailing Address - Phone:361-939-6553
Mailing Address - Fax:
Practice Address - Street 1:205 S ENTERPRIZE PKWY
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-4118
Practice Address - Country:US
Practice Address - Phone:361-939-6553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IA001373103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health