Provider Demographics
NPI:1245395037
Name:PAYNE, MARCI CATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:CATHLEEN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19401 E US HIGHWAY 40 STE 140
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5400
Mailing Address - Country:US
Mailing Address - Phone:816-373-6761
Mailing Address - Fax:
Practice Address - Street 1:19401 E US HIGHWAY 40 STE 140
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5400
Practice Address - Country:US
Practice Address - Phone:816-373-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000713101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2082133OtherCIGNA PROVIDER NUMBER
MO103324OtherCENPATICO PROVIDER NUMBER
MO30165015OtherBC PROVIDER NUMBER