Provider Demographics
NPI:1285968651
Name:JAYCOX, LAURA B (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:JAYCOX
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 AVONDALE SPRING DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7995
Mailing Address - Country:US
Mailing Address - Phone:636-795-0738
Mailing Address - Fax:
Practice Address - Street 1:1307 AVONDALE SPRING DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7995
Practice Address - Country:US
Practice Address - Phone:636-795-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist