Provider Demographics
NPI:1659568707
Name:LAYNE, JORDAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:LAYNE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 ZOE CIR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7313
Mailing Address - Country:US
Mailing Address - Phone:305-332-6501
Mailing Address - Fax:
Practice Address - Street 1:3189 LITTLE SILVER RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6705
Practice Address - Country:US
Practice Address - Phone:850-682-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist