MEDICARE: MS. PATRICIA HAGEMAN LAYBOURN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	20191	CA

General Provider Information

NPI Number	:	1184973695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA HAGEMAN LAYBOURN LMFT

Provider Business Mailing Address
First Line	:	1010 PINECREST AVE
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3853
Country	:	US
Telephone Number	:	858-386-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	16776 BERNARDO CENTER DR
Second Line	:	SUITE 203
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2534
Country	:	US
Telephone Number	:	858-386-6791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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