Provider Demographics
NPI:1194558056
Name:TRAYLOR, CYNTHIA (LCSW, CCM)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TRAYLOR
Suffix:
Gender:
Credentials:LCSW, CCM
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:TRAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, CCM
Mailing Address - Street 1:4855 MAGNOLIA COVE DR APT 165
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2288
Mailing Address - Country:US
Mailing Address - Phone:281-922-8837
Mailing Address - Fax:
Practice Address - Street 1:4855 MAGNOLIA COVE DR APT 165
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-2288
Practice Address - Country:US
Practice Address - Phone:281-922-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical