Healthcare Provider Details

I. General information

NPI: 1013630151
Provider Name (Legal Business Name): CARLEY LAINE COTE LAC, ATR, CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E MISSOURI AVE STE B127
PHOENIX AZ
85014-2478
US

IV. Provider business mailing address

321 E 10TH AVE
MESA AZ
85210-8705
US

V. Phone/Fax

Practice location:
  • Phone: 480-526-4427
  • Fax:
Mailing address:
  • Phone: 480-442-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451022561
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23165
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number22-585
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: