Provider Demographics
NPI:1093841082
Name:PAYNE, LORI SUE (LPC, LPC-S)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SUE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPC, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 S STONEBRIDGE DR STE 803
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8058
Mailing Address - Country:US
Mailing Address - Phone:972-741-0839
Mailing Address - Fax:469-519-2404
Practice Address - Street 1:3900 S STONEBRIDGE DR STE 803
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8058
Practice Address - Country:US
Practice Address - Phone:972-741-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17803101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1783391-01Medicaid