Provider Demographics
NPI:1356837934
Name:PAYNE, X'ZAVIER O
Entity Type:Individual
Prefix:
First Name:X'ZAVIER
Middle Name:O
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N STATE HIGHWAY 360 APT 2214
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8716
Mailing Address - Country:US
Mailing Address - Phone:682-772-7625
Mailing Address - Fax:
Practice Address - Street 1:420 N STATE HIGHWAY 360 APT 2214
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8716
Practice Address - Country:US
Practice Address - Phone:682-772-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness