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General NPI Number Information
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NPI Number | 1225669336
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Entity Type | Individual
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Provider Name | LAVON LAYNE HEAD LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 1031 W PEARL ST
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City | GRANBURY
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State | TX
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Zip | 76048-1867
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Country | US
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Telephone | 559-816-3178
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Fax |
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Provider Business Mailing Address
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Address Line | 516 SMART STRIKE TRL
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City | GRANBURY
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State | TX
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Zip | 76049-7890
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Country | US
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Telephone | 559-816-3178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 106251
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 125385
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License Number State | CA
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