Provider Demographics
NPI:1407137029
Name:PAYNE, LEAH (LPE)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:PAIGE
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPE
Mailing Address - Street 1:1405 N PIERCE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5379
Mailing Address - Country:US
Mailing Address - Phone:501-603-2147
Mailing Address - Fax:501-603-0324
Practice Address - Street 1:1405 N PIERCE ST STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5379
Practice Address - Country:US
Practice Address - Phone:501-603-2147
Practice Address - Fax:501-603-0324
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13-15E103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist