Healthcare Provider Details

I. General information

NPI: 1679326573
Provider Name (Legal Business Name): AMY LAYH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 09/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 PASEO REYES DR
ST AUGUSTINE FL
32095-8462
US

IV. Provider business mailing address

264 PASEO REYES DR
ST AUGUSTINE FL
32095-8462
US

V. Phone/Fax

Practice location:
  • Phone: 904-994-7127
  • Fax:
Mailing address:
  • Phone: 904-994-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: