Provider Demographics
NPI:1134521073
Name:LAYNE, CHARLA (MA, LPC)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:LAYNE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 BALD CYPRESS
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:522 S TEXAS BLVD
Practice Address - Street 2:STE 116
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6202
Practice Address - Country:US
Practice Address - Phone:956-373-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15532101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional