Provider Demographics
NPI:1497186522
Name:GOTTSCH, LAYNIE
Entity Type:Individual
Prefix:MRS
First Name:LAYNIE
Middle Name:
Last Name:GOTTSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-1426
Mailing Address - Country:US
Mailing Address - Phone:405-235-5671
Mailing Address - Fax:405-235-5686
Practice Address - Street 1:14 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-1426
Practice Address - Country:US
Practice Address - Phone:405-235-5671
Practice Address - Fax:405-235-5686
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor