Provider Demographics
NPI:1093466369
Name:SILLS-PAYNE, KERI (LMFT)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:SILLS-PAYNE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13877 CARLOW PARK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2149
Mailing Address - Country:US
Mailing Address - Phone:510-214-2486
Mailing Address - Fax:
Practice Address - Street 1:13877 CARLOW PARK DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2149
Practice Address - Country:US
Practice Address - Phone:510-214-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist