Provider Demographics
NPI:1366103285
Name:LLOYD, TRELLENE R (OWNER)
Entity type:Individual
Prefix:
First Name:TRELLENE
Middle Name:R
Last Name:LLOYD
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7181
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7181
Mailing Address - Country:US
Mailing Address - Phone:573-673-9320
Mailing Address - Fax:573-410-4066
Practice Address - Street 1:5303 SAPPHIRE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-4904
Practice Address - Country:US
Practice Address - Phone:573-590-0449
Practice Address - Fax:573-507-6033
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 103TB0200X, 103K00000X, 101YP2500X, 103TM1800X, 106S00000X
MO374U00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MONAMedicaid
MO874191495OtherMEDICAID & MEDICARE