Healthcare Provider Details

I. General information

NPI: 1831402445
Provider Name (Legal Business Name): DOUGLAS LAYER M.A., LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2010
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 COMMERCE DR STE B
LAS CRUCES NM
88011-8291
US

IV. Provider business mailing address

162 RED DEER CT
LAS CRUCES NM
88007-5247
US

V. Phone/Fax

Practice location:
  • Phone: 575-405-1990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0164031
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: