Healthcare Provider Details

I. General information

NPI: 1073680294
Provider Name (Legal Business Name): ROBERT JAMES LAYZOD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 PICCADILLY SQUARE DR STE 3
MOBILE AL
36609-5217
US

IV. Provider business mailing address

6312 PICCADILLY SQUARE DR STE 3
MOBILE AL
36609-5217
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5300
  • Fax:
Mailing address:
  • Phone: 251-343-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4021
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMASTERS
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: