MEDICARE: IAN LIGAYA DUMASLAN LAYNES

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	LPCC.0016784	CO
2	101YP2500X	Professional Counselor	LPC.0017503	CO

General Provider Information

NPI Number	:	1821643156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN LIGAYA DUMASLAN LAYNES

Provider Business Mailing Address
First Line	:	1210 S PARKER RD STE 210
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2163
Country	:	US
Telephone Number	:	720-477-0369
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 S PARKER RD STE 210
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2163
Country	:	US
Telephone Number	:	720-477-0369
Fax Number	:

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

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/05/2022

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