Basic Information
| Provider Information | |||||||||
| NPI: | 1720118466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAY | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 LANTON RD | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657753854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172562570 | ||||||||
| FaxNumber: | 4172566497 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 LANTON RD | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657753854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172562570 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 09/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2000151900 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 33739 | MO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 431116734 | 01 | EAP DEER OAKS | OTHER | 2786 | 01 | EAP IMPACT | OTHER | 11812140 | 01 | CAQH | OTHER | 922359 | 01 | HEALTHLINK PPO | OTHER | 922359 | 01 | HEALTHLINK HMO | OTHER |