MEDICARE: DR. JAMES LAWRENCE AYERS PH.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	103TC0700X	Clinical Psychologist	LP1724	MN

General Provider Information

NPI Number	:	1801969654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES LAWRENCE AYERS PH.D.

Provider Business Mailing Address
First Line	:	4000 18TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3338
Country	:	US
Telephone Number	:	612-721-6074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2421 CHICAGO AVE
Second Line	:	WALK-IN COUNSELING CENTER
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-3845
Country	:	US
Telephone Number	:	612-870-0565
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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