Provider Demographics
NPI:1528252004
Name:GAYLOR, TRACI SUE (LIMHP)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:SUE
Last Name:GAYLOR
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:S
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 E WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2969
Mailing Address - Country:US
Mailing Address - Phone:402-340-9092
Mailing Address - Fax:888-920-1942
Practice Address - Street 1:106 E WILSON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2969
Practice Address - Country:US
Practice Address - Phone:402-340-9092
Practice Address - Fax:888-920-1942
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8425101YM0800X
NE3742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025001500Medicaid