Provider Demographics
NPI:1144397340
Name:PAYNE, KELLIE A (LPCC LLCDC LSW)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:A
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPCC LLCDC LSW
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:A
Other - Last Name:PAYNE-SCHRAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC LLCDC LSW
Mailing Address - Street 1:2770 CENTENNIAL RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1829
Mailing Address - Country:US
Mailing Address - Phone:419-794-0567
Mailing Address - Fax:419-794-0569
Practice Address - Street 1:2770 CENTENNIAL RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1829
Practice Address - Country:US
Practice Address - Phone:419-794-0567
Practice Address - Fax:419-794-0569
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH975872101Y00000X
OHE0002484104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH975872OtherSTATE OF OH CHEMICAL DEPE
OHE0002484OtherSATE OF OHIO COUNSELOR
OHS0020474OtherSOCIAL WORKER