Provider Demographics
NPI:1073902995
Name:PAYNE, MARRANESHEIA
Entity Type:Individual
Prefix:
First Name:MARRANESHEIA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NESHEIA
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5208 MACKELMAN DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-4320
Mailing Address - Country:US
Mailing Address - Phone:405-248-2338
Mailing Address - Fax:
Practice Address - Street 1:5505 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-5508
Practice Address - Country:US
Practice Address - Phone:405-609-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor