Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY30898 | CA |
N | 103T00000X | Psychologist | PSY30898 | CA |
Y | 103G00000X | Clinical Psychologist | PSY30898 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY30898 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY30898 | CA |
NPI | 1043888100 |
---|---|
Provider Name | Dr. Christopher Merrill Layne |
First Address | Torrance, CA 90504-4915 |
Second Address | Torrance, CA 90504-4915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 15/06/2021 |