Reg A Ayres, LCP

Individual provider Active NPI Mental Health Counselor · Paola, KS

NPI 1659398642 · NPPES record last updated Feb 11, 2013

Key facts

NPI
1659398642
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
License
LCP 073 (KS)
Practice address
25955 W 327TH St
Paola, KS 66071-4920
Phone
(913) 557-9096
Fax
(913) 294-9247
NPI assigned
Jul 16, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare Care Compare profile

Specialty
Mental Health Counselor
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elizabeth Layton Center Inc (25 clinicians)

Practice addresses (Care Compare)

25955 W 327TH St
Paola, KS 66071-4920
Phone (913) 557-9096

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20240117000183 KS Practitioner - Mental Health Counselor 4183518509 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
073KSMDAddiction (Substance Use Disorder) Counselor
LCP 073KSMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Elizabeth Layton Center, Inc. Current
since Jan 1, 2024
Accepting new patients
Elizabeth Layton Center, Inc. Past
since Feb 8, 2023
Accepting new patients

Locations

2537 Eisenhower Rd
Ottawa, KS 66067
Phone (785) 242-2183

25955 W 327th St
Paola, KS 66071
Phone (913) 557-9096

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LCP 073 KS Yes

Addresses

Primary practice location

25955 W 327TH St
Paola, KS 66071-4920

Mailing address

PO Box 677
Ottawa, KS 66067-0677
Phone (913) 557-9096

Other identifiers

IdentifierTypeStateIssuer
200431840AMedicaidKS

Other providers in Paola, KS

All providers in Paola, KS · Mental Health Counselor in Kansas

Sources for this page

Verify at the official NPI Registry.