Provider Demographics
NPI:1154578201
Name:THOMAS, TRAJANA (PSYD, LMFT)
Entity type:Individual
Prefix:
First Name:TRAJANA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:TRAJANA
Other - Middle Name:
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:616 CAMELLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-2438
Mailing Address - Country:US
Mailing Address - Phone:813-498-9349
Mailing Address - Fax:
Practice Address - Street 1:616 CAMELLIA AVE
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-2438
Practice Address - Country:US
Practice Address - Phone:813-498-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9201103TC0700X
FLMT2340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist