Provider Demographics
NPI:1083088306
Name:PAYNE, RACHEL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:MIEDEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC-INTERN
Mailing Address - Street 1:224 COLT DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 CHIEFTAIN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1580
Practice Address - Country:US
Practice Address - Phone:972-850-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional