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General NPI Number Information
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NPI Number | 1285094193
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Entity Type | Individual
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Provider Name | KERRIS LAYNE
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Gender | Female
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 7141 S WESTERN AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-2000
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Country | US
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Telephone | 405-339-2097
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6211
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City | MOORE
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State | OK
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Zip | 73153-0211
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Country | US
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Telephone | 405-339-2097
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 00000000000000000000
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License Number State | OK
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