MEDICARE: LAYNE STOOPS

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	261Q00000X	Clinic/Center	MC60115047	WA
2	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	LPC-4376	ID
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	LPC-4376	ID

General Provider Information

NPI Number	:	1568772655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAYNE STOOPS

Provider Business Mailing Address
First Line	:	1212 N WASHINGTON ST
Second Line	:	ONE ROCK POINTE, SUITE 104
City	:	SPOKANE
State	:	WA
Zip	:	99201-2403
Country	:	US
Telephone Number	:	509-953-9961
Fax Number	:	509-232-0883

Provider Business Practice Location Address
First Line	:	1212 N WASHINGTON ST
Second Line	:	ONE ROCK POINTE, SUITE 104
City	:	SPOKANE
State	:	WA
Zip	:	99201-2403
Country	:	US
Telephone Number	:	509-953-9961
Fax Number	:	509-232-0883

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LAYNE STOOPS
Credential	:	M.ED.
Telephone Number	:	509-953-9961

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/07/2010

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