Provider Demographics
NPI:1750157566
Name:LAYTON, NICHOLAS W
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:W
Last Name:LAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:MO
Mailing Address - Zip Code:63867-9192
Mailing Address - Country:US
Mailing Address - Phone:573-703-7974
Mailing Address - Fax:
Practice Address - Street 1:221 EAGLE DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:MO
Practice Address - Zip Code:63867-9192
Practice Address - Country:US
Practice Address - Phone:573-703-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst