MEDICARE: MACKENZIE LAYNE

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	101YM0800X	Mental Health Counselor		OR

General Provider Information

NPI Number	:	1457216103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE LAYNE

Provider Business Mailing Address
First Line	:	4090 BECK AVE SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97317-5617
Country	:	US
Telephone Number	:	503-999-1536
Fax Number	:	503-999-1536

Provider Business Practice Location Address
First Line	:	6444 FAIRWAY AVE SE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-3073
Country	:	US
Telephone Number	:	971-901-2731
Fax Number	:	971-901-3065

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/17/2025

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Directions to “ MACKENZIE LAYNE ” Practice Location

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