Individual
MR. JERRY THOMAS TRAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1401 S 13TH ST, OZARK, MO 65721-8096
(417) 239-4368
(334) 513-1784
Mailing address
1401 S 13TH ST, OZARK, MO 65721-8096
(417) 239-4368
(334) 513-1784
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
02/20/2007
Last updated
11/18/2015
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