Provider Demographics
NPI:1417188236
Name:PAYNE, KATHLEEN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:T
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:T
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8374 PINE RUN
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36527-8638
Mailing Address - Country:US
Mailing Address - Phone:251-377-0430
Mailing Address - Fax:
Practice Address - Street 1:3929 AIRPORT BLVD STE 2-412
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2239
Practice Address - Country:US
Practice Address - Phone:251-512-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical