Provider Demographics
NPI:1225669336
Name:HEAD, LAVON LAYNE (LMFT)
Entity Type:Individual
Prefix:
First Name:LAVON
Middle Name:LAYNE
Last Name:HEAD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SMART STRIKE TRL
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-7890
Mailing Address - Country:US
Mailing Address - Phone:559-816-3178
Mailing Address - Fax:
Practice Address - Street 1:1031 W PEARL ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1867
Practice Address - Country:US
Practice Address - Phone:559-816-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106251106H00000X
CA125385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist