MEDICARE: LISA L LAYNE PH.D., L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2001032660	MO

General Provider Information

NPI Number	:	1306045109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA L LAYNE PH.D., L.P.C.

Provider Business Mailing Address
First Line	:	6301 ROCKHILL RD STE 105
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1117
Country	:	US
Telephone Number	:	816-444-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 ROCKHILL RD STE 105
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1117
Country	:	US
Telephone Number	:	816-444-6200
Fax Number	:	816-444-0329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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