Provider Demographics
NPI:1215375746
Name:PAYNE BEHAVIORAL MEDICINE
Entity Type:Organization
Organization Name:PAYNE BEHAVIORAL MEDICINE
Other - Org Name:PAYNE BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-506-8735
Mailing Address - Street 1:4005 N STATE ST STE N
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5755
Mailing Address - Country:US
Mailing Address - Phone:601-506-8735
Mailing Address - Fax:601-767-2747
Practice Address - Street 1:4005 N STATE ST STE N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5755
Practice Address - Country:US
Practice Address - Phone:601-506-8735
Practice Address - Fax:601-767-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS48841103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty