MEDICARE: TARA RENEE LAYMON PHD LPA LBA BCBA-D

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	103T00000X	Psychologist	5485	NC
2	103K00000X	Behavior Analyst	101	NC

General Provider Information

NPI Number	:	1558779785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA RENEE LAYMON PHD LPA LBA BCBA-D

Provider Business Mailing Address
First Line	:	4036 SHERRI LN
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-8390
Country	:	US
Telephone Number	:	484-557-3714
Fax Number	:

Provider Business Practice Location Address
First Line	:	8530 CLIFF CAMERON DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-5906
Country	:	US
Telephone Number	:	336-560-7878
Fax Number	:

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

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	04/20/2026

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